Treatment tactics in pediatric clavicle fractures

Introduction. One of the most common injuries in children is clavicle fractures. They account for up to 14 % of all pediatric bone injuries.

Aim. Comparative evaluation of the effectiveness of surgical and conservative methods of treating closed clavicle fractures in children.

Materials and methods. Between 2011 and 2018, 1,800 children with clavicle fractures referred to the traumatology and orthopedic department at the Children's Clinical Hospital No. 9 in Yekaterinburg.Most of them were treated conservatively, and 94 (5.2 %) children were hospitalized for surgical treatment. Depending on age and type of displacement, children received different conservative treatments, such as Deso dressing in children under two years old, figure-eight-bandage in children over two years of age. Surgical treatment was open reduction of fragments and fixation with either a Kirschner wire or a titanium elastic nail (TEN); titanium plates were used in several cases. For a comparative assessment of the results of the treatment methods for clavicle fractures, two groups of patients were formed.

Results. Shortening of consolidated clavicle was not observed in children of the main group treated surgically. In several cases, the elongation of the clavicle was revealed by no more than 1 cm. Patients in the comparison group showed shortening of the broken clavicle in three cases, no more than 1.3 cm.

Conclusion. After surgical treatment, the length of the shoulder girdle was fully restored; insignificant shortening after conservative treatment did not cause functional disorders.

1. Zorin V.I., Zhila N.G., Petrov G.G. Antropometricheskaia kharakteristika plechevogo poiasa pri perelomakh kliuchitsy u detei [Anthropometric characteristics of the shoulder girdle for fractures of the clavicle in children]. Dalnevostochnyi Meditsinskii Zhurnal [Far Eastern Medical Journal], 2008, no. 4, pp. 59-61. (in Russian)

2. Islentev A.V., Shapar V.D., Strelkov N.S., Kamenskikh M.S. Metod lecheniia perelomov kliuchitsy u detei s pomoshchiu ustroistva dlia repozitsii i fiksatsii [A method of treating clavicular fractures in children using a device for reposition and fixation]. Ortopediia, Travmatologiia i Protezirovanie [Orthopaedics, Traumatology and Prosthetics], 2012, no. 1, pp. 86-87. (in Russian)

3. Alkalaev S.B., Kopysova V.A., Fomichev M.V. Metody lecheniia perelomov kliuchitsy [Methods of treating clavicular Fractures]. Vestnik Novosibirskogo Gosudarstvennogo Universiteta. Seriia: Biologiia, Klinicheskaia Meditsina [Bulletin of the Novosibirsk University. Series: Biology, Clinical Medicine], 2008, vol. 6, no. 3-1, pp. 127-136. (in Russian)

4. Zorin V.I., Zhila N.G. Osobennosti operativnogo lecheniia povrezhdenii i porokov razvitiia kliuchitsy u detei [Special features of surgical treatment of injuries and malformations of the clavicle in children]. Khabarovsk, DGMU [Far Eastern State Medical University] Publ., 2012, 216 p. (in Russian)

5. Stepanyan H., Hennrikus W., Flynn D., Gendelberg D. Complex clavicle fractures in children: Kids are not little adults. Trauma (United Kingdom), 2019, vol. 21, no. 1, pp. 35-39. DOI: 10.1177/1460408617724815

6. Zhila N.G., Komarov P.B., Komarov K.M., Khrulev D.A., Ananev D.V. Sovremennyi podkhod k spitsevoi fiksatsii pri perelomakh kliuchitsy u detei [A modern approach to wire fixation for fractures of the clavicle in children]. Sbornik materialov Resp. Nauch.-prakt. Konf. s mezhdunar. uchastiem, posviashch. 70-letnemu iubileiu d-ra med. nauk, Prof. B.K. Dzhenalaeva “Aktualnye Voprosy Okhrany Zdorovia Detei” [Proceedings of Republican Scientific-Practical Conference with international participation, dedicated to 70-th Anniversary of M.D., Ph.D., Professor B.K. Dzhenalaev “Actual Problems of Child Health Protection»], 2018, vol. 3. (in Russian) Available at: http://elib.zkgmu.kz/xmlui/handle/123456789/328

7. Diushenaliev B.B., Mamytov E.B., Akimbaev M.A. Osteosintez stiagivaiushchimi ustroistvami pri perelomakh kliuchitsy [Osteosynthesis with tightening devices for fractures of the clavile]. Vestnik Kyrgyzsko-Rossiiskogo Slavianskogo Universiteta [Bulletin of the Kyrgyz-Russian Slavic University], 2017, vol. 17, no. 3, pp. 18-19. (in Russian)

8. Tuliaganov D.B., Porsakhonov R.G., Nishonov Kh.T., Nakhavlboev R.T., Mamatkulov Zh.A., Abdurakhmonov B.M. Sluchai uspeshnogo udaleniia spitsy, migrirovavshei v plevralnuiu polost posle osteosinteza kliuchitsy [The case of successful removal of the wire that migrated to the pleural cavity after osteosynthesis of the clavicle]. Vestnik Ekstrennoi Meditsiny [Bulletin of Emergency Medicine], 2019, vol. 12, no. 2, pp. 97-99. (in Russian)

9. Islentev A.V., Shapar V.D., Strelkov N.S., Kamenskikh M.S. Sovremennoe sostoianie voprosa lecheniia patsientov s perelomami kliuchitsy [Current status of the problem related to treatment of patients with clavicular fractures]. Vestnik Eksperimentalnoi i Klinicheskoi Khirurgii [Bulletin of Experimental and Clinical Surgery], 2012, vol. 5, no. 2, pp. 492-496. (in Russian)