Rabhi C, Orfeuvre B, Eid A, Griffet J, Rabattu P Y, Courvoisier A
Department of Pediatric Ortopaedic, Universitary Hospital Couple-Enfant, CHU of Grenoble-Alpes, France; University of Grenoble-Alpes, France.
Department of Pediatric Ortopaedic, Universitary Hospital Couple-Enfant, CHU of Grenoble-Alpes, France; University of Grenoble-Alpes, France.
Int J Surg Case Rep. 2021 Mar;80:105656. doi: 10.1016/j.ijscr.2021.105656. Epub 2021 Feb 18.
Proximal physeal fracture of the medial clavicular physis is a rare specific injury occurring in the immature skeletal. Several studies describe unilateral cases with posterior or anterior displacement and the following complications (vascular and mediastinal compression). An immediate diagnosis and management are necessary to avoid complications. The clinical diagnostic might be obvious or difficult, pain and swelling in the sternoclavicular joint area, sometimes a deformity and focal tenderness. A chest X-Ray may help and a three-dimensional reconstructed computed tomography scan has to be done to evaluate the lesions before surgery. The imaging is useful to confirm and specify the diagnostic and the displacement.
This case report presents 4 cases of proximal physeal fracture of the medial clavicular physis in 2 male-teenagers with bilateral displacement, one posterior and the other asymmetric.
After reviewing the literature of the unilateral clavicular physeal fracture, we can conclude that the ideal management of these injuries has not been well described. An open reduction associated an osteosuture with non-resorbable suture was performed. One-year follow-up, both of them had full recovery without any functional impact or any complains. This management of the proximal physeal fracture of the medial clavicle on children shows an excellent result according our cases and the literature.
The purpose of this study is to evaluate the functional impact of osteosuture in medial bilateral clavicular physeal fracture in teenagers after 1-year follow-up.
内侧锁骨骨骺近端骨折是一种发生于未成熟骨骼的罕见特殊损伤。多项研究描述了单侧病例伴有后移位或前移位以及随后的并发症（血管和纵隔受压）。为避免并发症，需要立即进行诊断和处理。临床诊断可能明显或困难，表现为胸锁关节区域疼痛和肿胀，有时出现畸形和局部压痛。胸部X线检查可能有帮助，术前必须进行三维重建计算机断层扫描以评估损伤情况。影像学检查有助于确诊并明确诊断及移位情况。
本病例报告呈现了2例青少年男性双侧移位的内侧锁骨骨骺近端骨折病例，1例为后移位，另1例为不对称移位。
在回顾单侧锁骨骨骺骨折的文献后，我们可以得出结论，这些损伤的理想处理方法尚未得到充分描述。我们进行了切开复位并采用不可吸收缝线进行骨缝合。随访1年，两人均完全康复，无任何功能影响或不适主诉。根据我们的病例及文献，这种对儿童内侧锁骨近端骨骺骨折的处理方法显示出了极佳的效果。
本研究的目的是在随访1年后评估骨缝合对青少年双侧内侧锁骨骨骺骨折的功能影响。
