[Dislocated midclavicular fractures in children and adolescents: who benefits from operative treatment?].

BACKGROUND

Displaced midclavicular fractures in children are generally treated non-operatively. But there is a lack of age-related data concerning the functional and cosmetic results following conservative treatment and patients' content with the treatment.

PATIENTS AND METHODS

In patients with displaced midclavicular fractures complications and pain was evaluated in relation to treatment option and age. Outcome was measured with the Constant Shoulder Score, a client satisfaction questionnaire (ZUV-8) about the satisfaction with the treatment and the cosmetic result and ultrasound of both clavicles.

RESULTS

A review of emergency room and fracture clinic records revealed 101 children and adolescents in whom displaced midclavicular fracture had been treated between 1/1997 and 12/2007. The follow-up included 59 patients with 60 fractures 1-10 years after the accident. Of those, 50 fractures were treated with a sling and 10 by operation. All patients under the age of ten were treated conservatively and reached very good functional and cosmetic results. Only an eight-year-old girl suffered from a painful pseudarthrosis. After resection and stabilisation by flexible intramedullary nailing, the outcome was excellent. Patients over the age of ten received a conservative treatment in 28 cases and ten had an operation (K-wires fixation n=2, elastic stable intramedullary nail n=8 in 7 patients). Functional outcome independent of treatment method was as good as in younger children, but the global and cosmetic satisfaction score was much lower. Older patients with a non-operative treatment suffered from more pain and were dissatisfied with the long immobilisation.

CONCLUSION

The method of choice in children under the age of ten with a displaced clavicular fracture is the non-surgical treatment supported by sufficient pain medication. Older children reach good results but suffer from more pain and are dissatisfied by the cosmetic results and immobilisation. Because of this, active older children and adolescents with a displaced clavicular fracture benefit from elastic stable intramedullary nailing.