Curtis R J
University of Texas Health Science Center, San Antonio.
Orthop Clin North Am. 1990 Apr;21(2):315-24.
Fractures about the shoulder in children rarely require operative treatment. Exceptions include open fractures and those associated with neurovascular compromise. Fractures of the proximal humerus in older children that cannot be adequately reduced and maintained should be treated with open reduction and internal fixation. Interposition of periosteum and biceps tendon can lead to difficulty in fracture reduction. Irreducible displaced fractures of the clavicular shaft, fractures that develop nonunion, and congenital pseudarthrosis of the clavicle can be treated by an intramedullary pin technique with bone grafting. Posterior displacement of fractures of the medical clavicle sometimes become an orthopedic emergency. Reduction by closed or open means should be accomplished to relieve compression of mediastinal structures. This injury does not require internal fixation. Types IV, V, and VI distal clavicle injuries require open reduction and reefing of the periosteal tube with occasional need for temporary lag-screw fixation. There is some debate about the type III injury. Large glenoid fractures involving the anterior rim that are associated with instability of the glenohumeral joint are best treated by open reduction and internal fixation.
儿童肩部骨折很少需要手术治疗。例外情况包括开放性骨折以及伴有神经血管损伤的骨折。年龄较大儿童的肱骨近端骨折若无法充分复位并维持，则应行切开复位内固定治疗。骨膜和肱二头肌肌腱嵌入可导致骨折复位困难。锁骨骨干不可复位的移位骨折、发生骨不连的骨折以及先天性锁骨假关节，可采用髓内针技术并植骨治疗。内侧锁骨骨折的后移位有时会成为骨科急症。应通过闭合或开放方法进行复位，以解除对纵隔结构的压迫。这种损伤不需要内固定。IV型、V型和VI型锁骨远端损伤需要切开复位并收紧骨膜管，偶尔需要临时拉力螺钉固定。关于III型损伤存在一些争议。累及前边缘且伴有盂肱关节不稳定的大型肩胛盂骨折，最好采用切开复位内固定治疗。
