Department of Trauma Surgery and Orthopedics, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany.
Section of Pediatric Traumatology (Sektion Kindertraumatologie, SKT) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU), Berlin, Germany.
PLoS One. 2020 Dec 28;15(12):e0244209. doi: 10.1371/journal.pone.0244209. eCollection 2020.
Dislocations of the sternoclavicular joint (anterior/posterior) and acromioclavicular joint (SCJ and ACJ, respectively) are rare injuries in childhood/adolescence, each having its own special characteristics. In posterior SCJ dislocation, the concomitant injuries in the upper mediastinum are most important complication, while in anterior SCJ dislocation there is a risk of permanent or recurrent instability.
In a retrospective analysis from seven pediatric trauma centers under the leadership of the Section of Pediatric Traumatology of the German Trauma Society, children (<18 years) were analyzed with focus on age, gender, trauma mechanism, diagnostics, treatment strategy and follow-up results. Additional epidemiological big data analysis from routine data was done.
In total 24 cases with an average age of 14.4 years (23 boys, 1 girl) could be evaluated (7x ACJ dislocation type ≥ Rockwood III; 17x SCJ dislocation type Allman III, including 12 posterior). All ACJ dislocations were treated surgically. Postoperative immobilization lasted 3-6 weeks, after which a movement limit of 90 degrees was recommended until implant removal. Patients with SCJ dislocation were posterior dislocations in 75%, and 15 of 17 were treated surgically. One patient had a tendency toward sub-dislocation and another had a relapse. Conservatively treated injuries healed without complications. Compared to adults, SCJ injuries were equally rarely found in children (< 1% of clavicle-associated injuries), while pediatric ACJ dislocations were significantly less frequent (p<0.001).
In cases of SCJ dislocations, our cohort analysis confirmed both the heterogeneous spectrum of the treatment strategies in addition to the problems/complications based on previous literature. The indication for the operative or conservative approach and for the specific method is not standardized. In order to be able to create evidence-based standards, a prospective, multicenter-study with a sufficiently long follow-up time would be necessary due to the rarity of these injuries in children. The rarity was emphasized by our routine data analysis.
胸锁关节（前/后）和肩锁关节（SCJ 和 ACJ）脱位在儿童/青少年中较为罕见，每种关节脱位都有其自身的特殊特征。在 SCJ 后脱位中，上纵隔的伴随损伤是最重要的并发症，而在前 SCJ 脱位中存在永久性或复发性不稳定的风险。
在德国创伤学会小儿创伤学分会领导下的七个小儿创伤中心的回顾性分析中，重点分析了年龄、性别、创伤机制、诊断、治疗策略和随访结果。此外，还对常规数据进行了额外的流行病学大数据分析。
共评估了 24 例患儿（平均年龄 14.4 岁，23 例男孩，1 例女孩）（7x ACJ 脱位类型≥Rockwood III；17x SCJ 脱位类型 Allman III，包括 12 例后脱位）。所有 ACJ 脱位均采用手术治疗。术后固定时间为 3-6 周，之后建议在取出植入物之前将活动限制在 90 度。SCJ 脱位患者中，后脱位占 75%，17 例中有 15 例采用手术治疗。1 例有半脱位倾向，1 例有复发。保守治疗的损伤愈合无并发症。与成人相比，儿童 SCJ 损伤同样罕见（<锁骨相关损伤的 1%），而儿童 ACJ 脱位明显较少（p<0.001）。
在 SCJ 脱位病例中，我们的队列分析证实了基于既往文献的治疗策略的异质性，以及基于既往文献的问题/并发症。手术或保守治疗的适应证和具体方法尚未标准化。为了能够制定基于证据的标准，由于这些损伤在儿童中罕见，需要进行一项前瞻性、多中心研究，并且随访时间足够长。我们的常规数据分析强调了这种损伤的罕见性。
