Outcome of distal clavicular fracture separations and dislocations in immature skeleton
Savvas P Nenopoulos1, Ioannis P Gigis, Anastasios A Chytas
12nd Orthopaedic Department of Aristotle University of Thessaloniki, General Hospital G. Gennimatas, Thessaloniki, Greece. savanen42@hotmail.com
Insights
This study introduces a new classification for pediatric distal clavicle fractures, showing excellent long-term outcomes with both surgical and conservative treatments. Older children with significant displacement may benefit from surgery for better cosmetic results.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Sports Medicine
Background:
- Limited long-term data exists for pediatric distal clavicle injuries.
- Current treatment strategies for these fractures are not well-defined.
Purpose of the Study:
- To propose a novel classification system for distal clavicle fractures based on fracture pattern and displacement.
- To evaluate the long-term follow-up of treated pediatric distal clavicle injuries.
- To establish a treatment algorithm for these injuries.
Main Methods:
- A retrospective study was conducted from 1983 to 2008.
- Seventy-five pediatric patients (ages 3-16) with distal clavicle injuries were analyzed.
- Injuries were classified into five groups based on fracture pattern and displacement; treatment was either conservative (63 patients) or surgical (12 patients).
Main Results:
- Fifty-nine patients were re-examined after a 2-18 year follow-up.
- Excellent functional outcomes (Constant score) were observed in 52 patients, with no loss of shoulder motion in undisplaced fractures.
- Minor motion loss occurred in seven patients with displaced fractures; conservative treatment led to visible prominence in five patients.
Conclusions:
- The proposed classification system is simple and aids in therapeutic decision-making for distal clavicle fractures.
- Both conservative and surgical treatments yield excellent functional results.
- Surgical intervention may offer superior cosmetic outcomes for older children (>8 years) with significantly displaced fractures (groups IIb, IIIb, IV, V).
Background:
There are only a few studies with long-term follow-up of distal clavicular injuries in children and their treatment is not clearly defined. The purpose of our study is to suggest a new classification system according to the fracture pattern and the degree of the displacement, to evaluate the long-term follow-up and also to propose an algorithm for treatment.
Methods:
We conducted a retrospective study from 1983 to 2008. Seventy-five children and adolescents, age ranging from 3 to 16 years (46 >8 years), were treated in our department. We classified all these injuries into five groups according to the fracture pattern and into subgroups according to the displacement of the bony particles: greenstick fractures as group I, transverse fractures as group II, oblique fractures as group III (IIa and IIIa: undisplaced, IIb and IIIb: displaced), comminuted fractures as group IV and true dislocation of the acromioclavicular joint as group V. Sixty-three patients were treated conservatively, while 12 sustained surgical treatment.
Results:
Fifty-nine patients were re-examined after 2-18 years. All the patients included in groups I, IIa and IIIa had no loss in the motion of their shoulder. Seven of the 29 patients in groups IIb, IIIb, IV and V appeared to have minor loss of motion. A constant score was noted in 52 patients and the results were excellent. None of the patients complained of limitations in daily activities, while five patients, who were treated conservatively, complained of visible prominence at the fracture site. One of them had a clavicular duplication, while another patient treated surgically complicated with coracoclavicular synostosis.
Conclusion:
The aforementioned proposed classification of these injuries is based on the fracture pattern and is simple, leading to decision making concerning therapy of these injuries. The functional results after a distal clavicle fracture will be excellent, either after conservative or surgical treatment. Older patients (>8 years) from groups IIb, IIIb, IV and V, with greater displacement, could be treated surgically to have better cosmetic results.
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