Related Experiment Videos
Operative management of children's fractures of the shoulder region
1University of Texas Health Science Center, San Antonio.
Insights
Pediatric shoulder fractures typically need non-operative care, but surgical intervention is necessary for open fractures or those with neurovascular issues. Specific clavicle and proximal humerus fractures may require surgical repair for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Management
Background:
- Shoulder and clavicle fractures in children are common pediatric orthopedic injuries.
- Most pediatric fractures heal well with non-operative management.
- Specific fracture patterns may present challenges requiring operative consideration.
Purpose of the Study:
- To outline the indications for operative intervention in pediatric shoulder and clavicle fractures.
- To describe surgical techniques for managing complex pediatric fractures.
- To provide guidance on the treatment of specific fracture types, including proximal humerus, clavicle, and distal clavicle injuries.
Main Methods:
- Review of current literature and established treatment guidelines for pediatric shoulder and clavicle fractures.
- Analysis of indications for surgical versus non-surgical management based on fracture type, displacement, and associated complications.
- Description of surgical techniques such as open reduction and internal fixation, intramedullary pinning, and reefing of the periosteal tube.
Main Results:
- Operative treatment is rarely needed for pediatric shoulder fractures, except for open fractures or those with neurovascular compromise.
- Proximal humerus fractures in older children may require open reduction and internal fixation if reduction is inadequate.
- Clavicular fractures, including irreducible shaft fractures, nonunions, and congenital pseudarthrosis, can be managed with intramedullary pinning and bone grafting. Posteriorly displaced medial clavicle fractures are an emergency requiring reduction.
- Distal clavicle injuries (Types IV-VI) necessitate open reduction and periosteal reefing, sometimes with lag-screw fixation. Large glenoid rim fractures with instability require open reduction and internal fixation.
Conclusions:
- Non-operative management is the mainstay for most pediatric shoulder and clavicle fractures.
- Surgical intervention is reserved for specific complex cases, including open fractures, neurovascular compromise, irreducible fractures, nonunions, and certain distal clavicle injuries.
- Timely reduction of medially displaced clavicle fractures is crucial to prevent mediastinal compression.
Abstract:
Fractures about the shoulder in children rarely require operative treatment. Exceptions include open fractures and those associated with neurovascular compromise. Fractures of the proximal humerus in older children that cannot be adequately reduced and maintained should be treated with open reduction and internal fixation. Interposition of periosteum and biceps tendon can lead to difficulty in fracture reduction. Irreducible displaced fractures of the clavicular shaft, fractures that develop nonunion, and congenital pseudarthrosis of the clavicle can be treated by an intramedullary pin technique with bone grafting. Posterior displacement of fractures of the medical clavicle sometimes become an orthopedic emergency. Reduction by closed or open means should be accomplished to relieve compression of mediastinal structures. This injury does not require internal fixation. Types IV, V, and VI distal clavicle injuries require open reduction and reefing of the periosteal tube with occasional need for temporary lag-screw fixation. There is some debate about the type III injury. Large glenoid fractures involving the anterior rim that are associated with instability of the glenohumeral joint are best treated by open reduction and internal fixation.