Liebs Thoralf R, Ryser Basil, Kaiser Nadine, Slongo Theddy, Berger Steffen, Ziebarth Kai
Department of Pediatric Orthopaedics and Traumatology, Clinic for Pediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland.
J Pediatr Orthop. 2019 Aug;39(7):e542-e547. doi: 10.1097/BPO.0000000000001332.
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.
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%.
Treatment was conservative in all cases but one. In these cases, after a mean follow-up of 6.5 years (range, 1 to 13.2 y), the mean Quick-DASH was 1.2 (SD, 4.4) at a scale of 0 to 100, with lower values representing better quality of life. The mean physical function score of the Peds-QL was 97.8 (SD, 4.4), and the mean psychosocial function score was 91.8 (SD, 10.8), both at a scale of 0 to 100, with higher values representing better quality of life.There was no statistically significant association of age at the time of injury on the primary outcome Quick-DASH.There were no statistically significant associations between fracture or displacement patterns with regard to health-related quality of life.
Conservative treatment of lateral clavicular fractures in children and adolescents is associated with excellent health-related quality of life, as measured with the disease-specific Quick-DASH and the non-disease-specific Peds-QL at a mean follow-up of 6.5 years (range, 1 to 13.2 y). There was no effect of age at the time of injury, and we were unable to identify associations to commonly analyzed risk factors, such as displacement patterns.As the conservative treatment of this type of fracture in children and adolescents is associated with such a good health-related quality of life, it is unlikely that these results could be further improved by surgical interventions.
Level IV-case series.
儿童锁骨外侧三分之一骨折后的健康相关生活质量尚不清楚。鉴于文献中成人锁骨骨折手术治疗的趋势，我们经常收到儿童外侧锁骨骨折手术治疗的转诊。因此，我们研究了：（1）在一家大型地区性儿科创伤中心接受治疗的童年时期发生锁骨外侧三分之一骨折患者的健康相关生活质量；（2）健康相关生活质量是否与受伤时的年龄相关；（3）骨折和移位模式是否与健康相关生活质量相关。
这是一项回顾性病例系列研究。我们确定了69例患者（21名女孩和48名男孩），他们在2004年1月至2015年6月期间发生了锁骨外侧三分之一骨折。这些患者被要求填写一份问卷，其中包括手臂、肩部和手部功能障碍快速评估量表（DASH）简版（主要结局指标）和儿童生活质量量表（Peds-QL）。截至2017年7月，我们收到了其中56例患者的回复，随访率为81%。
除1例病例外，所有病例均采用保守治疗。在这些病例中，平均随访6.5年（范围1至13.2年）后，DASH量表上的平均快速DASH评分为1.2（标准差4.4），评分范围为0至100，分数越低表示生活质量越好。Peds-QL量表上的平均身体功能评分为97.8（标准差4.4），平均心理社会功能评分为91.8（标准差10.8），评分范围均为0至100，分数越高表示生活质量越好。受伤时的年龄与主要结局指标快速DASH之间无统计学显著相关性。骨折或移位模式与健康相关生活质量之间无统计学显著相关性。
在平均随访6.5年（范围1至13.2年）时，采用疾病特异性的快速DASH和非疾病特异性的Peds-QL进行测量，儿童和青少年锁骨外侧骨折的保守治疗与优异的健康相关生活质量相关。受伤时的年龄没有影响，并且我们无法确定与常见分析的危险因素（如移位模式）之间的关联。由于儿童和青少年此类骨折的保守治疗与如此良好的健康相关生活质量相关，手术干预不太可能进一步改善这些结果。
IV级——病例系列。
