Complications After Plate Fixation of Displaced Pediatric Midshaft Clavicle Fractures

Li, Ying; Helvie, Peter F.; Farley, Frances A.; Abbott, Matthew D.; Caird, Michelle S.

doi:10.1097/bpo.0000000000000832

Cited by 39 publications

(59 citation statements)

References 24 publications

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“…In our study, refracture occurred in 2 patients that was consistent with previous reports [11,20,25], and both the fractures resulted from accidental fall after plate removal.…”

Section: Vas = Visual Analogue Scalesupporting

confidence: 92%

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Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

Rai²,

et al. 2020

Preprint

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Background: Traditionally, operative treatment for displaced midshaft clavicle fractures in adolescents has been achieved by a plate and screws. However, a minimally invasive trend in most of the surgeries has led the pediatric orthopedic surgeons to use elastic stable intramedullary nail (ESIN) for displaced midshaft clavicle fractures. This study aims to compare the clinical outcomes of adolescent patients who were surgically treated with the (ESIN) and plate for displaced midshaft clavicle fractures.Methods: A total of 73 patients, aged between 10 years and 14 years, with displaced midshaft clavicle fractures were treated surgically from January 2014 to January 2018. Patients were categorized into two groups, ESIN (n = 45; male 27, female 18) and plate (n = 28; male17, female 11) according to surgical technique. The preoperative data, including baseline information of the patients, radiographic parameters, and types of surgical procedure, were collected from the hospital database. The postoperative data, including clinical outcome and complications, were collected during the follow-up visit. Clinical outcome was evaluated using the American Shoulder and Elbow Surgeons (ASES).Results: The average age of the patients in the ESIN group was 12.2±1.5 years, and that in the Plate group was 12.2±1.4 years. There was a significantly less operative time, reduced estimated blood loss (EBL), shortened hospital stay and smaller incision for ESIN group as compared to the Plate group (P<0.01). The rate of scar concern was much higher in plate (14/28, 50%) than ESIN (2/45, 4.4%) , (P <0.01). There was no statistically significant difference in shoulder function between the ESIN group (94.5±2.8) and the Plate group (95.1±2.7), P = 0.36. In all the cases, implant removal was performed between 4 and 12 months postoperatively, and the ESIN group had significantly less operative time, EBL and shortened hospital stay as compared to the plate for implant removal (P<0.01).Conclusion: Both the ESIN and Plate are safe and effective treatment methods for displaced midshaft clavicle fractures in adolescents. The ESIN is superior to plate in terms of shorter operative time, less intraoperative radiation exposure, shorter hospital stay, less scar concern and easier implant removals. However, ESIN for heavier kids remain cautious.

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“…In our study, refracture occurred in 2 patients that was consistent with previous reports [11,20,25], and both the fractures resulted from accidental fall after plate removal.…”

Section: Vas = Visual Analogue Scalesupporting

confidence: 92%

“…Traditionally, operative treatment has been achieved by plate and screws [7,10,11]. Recently, intramedullary fixation is gaining increased interest in the literature [12,13].…”

Section: Introductionmentioning

confidence: 99%

Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

Rai²,

et al. 2020

Preprint

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“…[24]. However, the enthusiasm for surgery must take into account the significant complications such as brachial plexus or subclavian vessel injuries, pneumothorax [33], and infection [34,35] that have been reported following surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

Nawar

Eliya

Burrow

et al. 2020

Curr Rev Musculoskelet Med

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Purpose The purpose of this study is to compare the outcomes and complications of operative vs non-operative management of mid-diaphyseal clavicle fractures in the skeletally immature population. Recent Findings Traditionally, skeletally immature clavicle fractures have been managed non-operatively. However, there has been an increasing trend towards operative management with a lack of evidence indicating its effectiveness. Methods Two reviewers searched three online databases (MEDLINE, EMBASE and PubMed), independently and in duplicates, for literature comparing the outcomes and complications of operative versus non-operative management in skeletally-immature patients (defined as birth to 18 years of age) with a middiaphyseal clavicle fracture. Where possible, risk ratios (RR) and mean differences (MD) were combined using a random effects model. Results Seven studies, containing 522 skeletally immature patients (with 528 mid-diaphyseal clavicle fractures) with an age range of 8 to 18 years, with 148 patients undergoing operative management and 380 patients undergoing non-operative management, were included. Across the 6 studies that reported gender (N = 444), there were 335 males and 109 females. Patients were followed up from 2 weeks to 3.7 years across five studies (N = 201 patients) that reported follow-up time. There was no significant difference in the time to achieve union (p = 0.1), the time to return to activity (p = 0.09), and the overall complication rate (p = 0.50) between the operative and the non-operative groups. Summary There is no significant difference between operative and non-operative management of skeletally immature middiaphyseal clavicle fractures. Clinical equipoise exists to study this further by means of a prospective, randomized, blinded control trial. Level of Evidence Level IV, systematic review and meta-analysis of level II, III, and IV.

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“…7 This could explain why there is a trend in the literature to lower the age thresholds for considering surgery for these fractures. [13][14][15] One recent study recommended that children older than 8 years with displaced fractures of the lateral third could be treated surgically to have better cosmetic results, 16 and another publication described a new surgical technique for use in children. 4 Moreover, lateral clavicular fractures in children can mimic AC dislocations, 17,18 an injury that is commonly seen in adults, and wherein some authors also recommend surgery.…”

mentioning

confidence: 99%

Health-related Quality of Life After Fractures of the Lateral Third of the Clavicle in Children and Adolescents

Liebs

Ryser²,

Kaiser³

et al. 2019

Journal of Pediatric Orthopaedics

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Introduction: The health-related quality of life after pediatric fractures of the lateral third of the clavicle is unknown. Given the trend in the literature toward surgical management of clavicular fractures in adults, we frequently receive referrals for surgical management of lateral clavicular fractures in children. Therefore, we examined (1) the health-related quality of life of patients who sustained a fracture of the lateral third of the clavicle in childhood and who were treated at a large regional pediatric trauma center, (2) if the health-related quality of life was associated with the age at the time of the injury, and (3) whether fracture and displacement patterns were associated with health-related qualify of life. Methods: This is a retrospective case series. We were able to identify 69 patients (21 girls and 48 boys) who sustained a fracture of the lateral third of the clavicle between the period spanning from January 2004 to June 2015. These patients were asked to fill in a questionnaire that included the Quick version of the Disability of Arm, Shoulder, and Hand (DASH) (primary outcome) and the Pediatric Quality of Life Inventory (Peds-QL). Until July 2017, we were able to get a response from 56 of these patients, resulting in a follow-up of 81%.

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Complications After Plate Fixation of Displaced Pediatric Midshaft Clavicle Fractures

Abstract: Level IV-therapeutic.

Cited by 39 publications

References 24 publications

Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

Health-related Quality of Life After Fractures of the Lateral Third of the Clavicle in Children and Adolescents

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