Strauss Benjamin Jacob, Carey Timothy P, Seabrook Jamie A, Lim Rodrick
Schulich School of Medicine, the University of Western Ontario, London, Ontario, Canada.
J Emerg Med. 2012 Jul;43(1):29-35. doi: 10.1016/j.jemermed.2011.06.132. Epub 2012 Feb 10.
Clavicular fractures are the most common pediatric long-bone fracture, and although the vast majority heal with supportive treatment, complications do occur and can lead to pain and disability. Although many studies have characterized adult complication rates and risk factors, to our knowledge no comparable studies to date have looked at clavicular fractures in the pediatric population.
The study aim was to identify the radiological and clinical variables that increase the complication rate of clavicular fractures. Identification of these variables would help emergency physicians identify patients who require more thorough follow-up or surgical intervention.
We analyzed radiographs of 537 clavicular fractures on initial presentation to the Pediatric Emergency Department at the Children's Hospital at London Health Sciences Center over a 4-year period, collecting data on variables such as displacement, angulation, and comminution, as well as demographic data such as age and gender. We then determined the outcome of each fracture by reviewing each patient's chart, and through a logistic regression analysis, determined the variables associated with complications.
Of all the fractures treated supportively (i.e., non-operatively), only 2.5% resulted in a complication. Our analysis determined that patient age was an independent predictor of complications, with each year past zero conferring an 18.1% increase in risk of complication. Furthermore, completely displaced fractures were shown to increase the odds of complication by a factor of 3.2.
These findings help the emergency physician identify a group of high-risk pediatric patients with clavicular fractures for which more thorough follow-up should be considered.
锁骨骨折是儿童最常见的长骨骨折，尽管绝大多数骨折通过支持性治疗可愈合，但并发症确实会发生，并可能导致疼痛和残疾。虽然许多研究已经描述了成人的并发症发生率和危险因素，但据我们所知，迄今为止尚无类似研究关注儿童人群的锁骨骨折。
本研究旨在确定增加锁骨骨折并发症发生率的影像学和临床变量。识别这些变量将有助于急诊医生识别需要更全面随访或手术干预的患者。
我们分析了伦敦卫生科学中心儿童医院儿科急诊科在4年期间首次就诊的537例锁骨骨折的X线片，收集了诸如移位、成角和粉碎等变量的数据，以及年龄和性别等人口统计学数据。然后，我们通过查阅每位患者的病历确定每例骨折的结局，并通过逻辑回归分析确定与并发症相关的变量。
在所有接受支持性治疗（即非手术治疗）的骨折中，只有2.5%出现了并发症。我们的分析确定患者年龄是并发症的独立预测因素，年龄每增加一岁，并发症风险增加18.1%。此外，完全移位的骨折发生并发症的几率增加了3.2倍。
这些发现有助于急诊医生识别一组锁骨骨折的高危儿童患者，对于这些患者应考虑进行更全面的随访。
