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Surgery for Displaced Clavicle Shaft Fracture Good Option for Some Children
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Posted on: 12/10/2009
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Surgery for displaced clavicle shaft fractures, breaks in the collarbone that have shifted, is not a common method of treatment, although the fracture itself is not uncommon. The clavicle is one of the most frequently broken bones among children. Usual treatment is closed reduction, which means the bone is realigned and a sling is applied. This keeps the child from moving the arm and this allows the clavicle to heal.
This way of thinking was reinforced in the early 1960s, when two doctors shared their thoughts that there was no difference in treating this broken bone with surgery than by sling, so to avoid the risks of surgery, slings were preferred. However, studies of adults who had broken their collarbone and were treated with closed reduction have found that the healing is not as good as would have been wanted or expected. This led some doctors to think that if surgery is preferred for adult patients with fractured clavicles, perhaps this may be the case with some children, particularly older ones. The authors of this article wanted to investigate the outcome of surgical repair of displaced clavicle shaft fractures in children to see how they differed, if they differed, from the usual sling treatment used.
Recent research done on adults has raised doubts on to whether slings were really were as good as surgery. Some findings showed that the bones didn't join (non-union) between seven percent to 34 percent of the time when surgery was not done. Furthermore, 46 percent of patients didn't regain full use of their arm again. Research involving children is not common. The authors of this article were able to find two case series on surgical repair on children and these studies reported favorably on the results.
Following these types of findings, researchers investigated the records of 24 children (three girls) who had undergone surgery to repair a clavicle shaft fracture. The children ranged in age from seven to 16 years old. The surgeries involved inserting plates and screws to stabilize the fractured bone in 22 patients and wires in one. According to the records, 21 of the 24 patients were able to return to their sports activities, unrestricted, after they had healed. The other children didn't return, not because they couldn't, but because their mothers would not allow them to.
Although it may be that surgery could be preferable in some cases, there are other issues to take into account from concerns of infection and surgical complications, to parents' wishes that their child not be left with a scar if treatment can be done without surgery.
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References:
Charles T. Mehlman, DO, MPH, et al. Operative Treatment of Completely DIsplaced Clavicle Shaft Fractures in Children. In Journal of Pediatric Orthopedics. December 2009. Vol. 29. No. 8. Pp. 851 to 855.
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