Journal Reading bedah otto

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Journal Reading

by :

Juliet C. G. Umbas (C11108204)

Surgery Departement

Medical Faculty of Hasanuddin University

2013

Conservative Management of

Paediatric Clavicle FracturesBarry J. ONeill, Alan P.Molloy, and WilliamCurtin


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Clavicle fractures occur frequently, rates ranging

between 8% and 15% of all paediatric fractures

Vast majority of these injuries can be treated

nonoperatively with excellent results

The aim of this study was to review the outcome

of clavicle fractures in paediatric patients at our

institute and to determine the number of suchfractures that require operative management

Introduction


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We

retrospectivelyreviewed all

clavicle

fractures inchildren treated

at our institute

over a two-year

period

identify all

radiographs ofthe shoulder

region

performed inchildren aged

up to and

including 15

years old

reviewed to

identify all

clavicle

fractures in the

patient cohort

group

classificationof

each fracture,

treatmentmethod used,

duration of

radiographicfollowup,

duration of

clinical

followup, andclinical outcome

Methods


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Exclusion criteria

patient aged 16 years or older, and

any fracture as a result of birth trauma


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Results

487 claviclefractures in 483

patients treated

in our institute

during the two-

year period

190 clavicle

fractures satisfiedthe inclusion

criteria (39%)

135

fractures

in boys

55

fractures

in girls10 neonatus

excluded because

injury related birth

trauma283 patients

excluded because

16 years old orolder


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190 clavicle

fractures

124 undisplaced

(65%)

66 were

displaced (35%)


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All fractures were treated with analgesia and asimple broad-arm sling

Radiographs were taken at firstpresentation

mean radiographic follow-up of the group as awhole was 35 days (5 weeks), and the meanclinical follow-up was 44 days (6.3 weeks)

190 fractures: 44 (23%) had radiographicconfirmationof fracture healing. 77% hadradiographic examinations discontinued whenclinical symptoms of pain and limitation offunction had resolved


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All fractures in this study had healed clinically

when the child was discharged from follow-

up. All fractures healed clinically with non

operative management, and no children

required surgical intervention


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Discussion

Clavicle fractures are common injuries in general

there are surprisingly few published studies thatspecificallydiscuss pediatric clavicle fractures

Traditionally, clavicle fractures have been treatednonoperatively, particularly in children. This islargely due to the relatively low incidence ofcomplications following non-operative

management

Discussion


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Indications for operative management in the

acute setting have included

markedly displaced fractures with compromised

skin integrity,

open fractures,

concomitant vascular injury requiring repair, and

compromise of the brachial plexus


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Reports of complications of clavicle fractures

and operative management of clavicle

fractures in paediatric patients are few

In our group of 190 patients, none had

significantassociated injuries and none

required operative management


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Conclusions

As with all fractures, clavicle fractures candevelop complications regardless of management

Most published articles report these

complications in adult patients, and there is arelative paucity of the literature available that isspecificallyreporting upon clavicle fractures inchildren

Despite this,there are a small number of reportsof complications in this group

Conclusions


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In our experience, all paediatric clavicle

fractures can be treated with simple

immobilisation and analgesia, without

development of complications

Radiographic review of paediatric clavicle

fractures is unnecessary in the absence of

clinical findingssuggestive of delayed union


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Thank You

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