Outcomes After Surgical Fixation of Posterior Sternoclavicular Physeal Fractures and Dislocations in Children.
Activities of Daily Living
Adolescent
Female
Fracture Fixation, Internal
/ adverse effects
Fractures, Bone
/ surgery
Humans
Joint Dislocations
/ surgery
Male
Outcome and Process Assessment, Health Care
Pain, Postoperative
/ diagnosis
Plastic Surgery Procedures
Recovery of Function
Retrospective Studies
Sternoclavicular Joint
/ injuries
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
pubmed:
6
10
2020
medline:
8
5
2021
entrez:
5
10
2020
Statut:
ppublish
Résumé
Acute sternoclavicular fractures and dislocations (SCFDs) are a rare but important injury in pediatric patients. SCFDs are either true dislocations, or more commonly, physeal fractures in children. The reduction is advised given the proximity to surrounding vascular structures, and some authors advocate for routine fixation given rates of redisplacement after closed reduction. The purpose of the current study was to provide validated long-term functional outcome data following open reduction and surgical fixation of pediatric SCFDs, as well as provide injury and demographic information. This is a retrospective observational study with a subset of patients reporting functional outcomes. Patients under the age of 18 that had surgically managed acute posterior SCFD from 1990 to 2018 were included. A retrospective chart review was performed to obtain demographic, clinical, and surgical details. Patients with a minimum of 6-month follow-up were contacted to assess outcomes. Functional outcomes of interest included QuickDash, Visual Analog Scale pain rating, Single Assessment Numeric Evaluation of shoulder function, and PROMIS Upper Extremity questionnaire. Statistical analysis included descriptive statistics. A total of 37 patients that sustained an acute posterior SCFD during the study period were included. The average age at the time of injury was 15.2±2.1 years and 89% were male. Patient-reported outcomes were obtained for 14 patients with a mean follow-up of 4.5 years. The mean QuickDash score was 5.1/100 with 0 being normal, and the mean Visual Analog Scale pain rating was 0.7/10. The mean Single Assessment Numeric Evaluation score was 96% with 100% being completely normal. The mean PROMIS score was 55 with 50 being the mean of the relevant reference population. Approximately 29% (4/14 patients) stated that their injury negatively affected their ability to participate in sports. There is a paucity of literature on functional outcomes after surgical management of pediatric acute posterior SCFD. Functional outcomes after surgery were satisfactory in this cohort with most patients being able to perform major activities of daily living. Additional future studies with larger cohorts and comparative groups are needed to better understand outcomes in this population. Level IV.
Sections du résumé
BACKGROUND
BACKGROUND
Acute sternoclavicular fractures and dislocations (SCFDs) are a rare but important injury in pediatric patients. SCFDs are either true dislocations, or more commonly, physeal fractures in children. The reduction is advised given the proximity to surrounding vascular structures, and some authors advocate for routine fixation given rates of redisplacement after closed reduction. The purpose of the current study was to provide validated long-term functional outcome data following open reduction and surgical fixation of pediatric SCFDs, as well as provide injury and demographic information.
METHODS
METHODS
This is a retrospective observational study with a subset of patients reporting functional outcomes. Patients under the age of 18 that had surgically managed acute posterior SCFD from 1990 to 2018 were included. A retrospective chart review was performed to obtain demographic, clinical, and surgical details. Patients with a minimum of 6-month follow-up were contacted to assess outcomes. Functional outcomes of interest included QuickDash, Visual Analog Scale pain rating, Single Assessment Numeric Evaluation of shoulder function, and PROMIS Upper Extremity questionnaire. Statistical analysis included descriptive statistics.
RESULTS
RESULTS
A total of 37 patients that sustained an acute posterior SCFD during the study period were included. The average age at the time of injury was 15.2±2.1 years and 89% were male. Patient-reported outcomes were obtained for 14 patients with a mean follow-up of 4.5 years. The mean QuickDash score was 5.1/100 with 0 being normal, and the mean Visual Analog Scale pain rating was 0.7/10. The mean Single Assessment Numeric Evaluation score was 96% with 100% being completely normal. The mean PROMIS score was 55 with 50 being the mean of the relevant reference population. Approximately 29% (4/14 patients) stated that their injury negatively affected their ability to participate in sports.
CONCLUSIONS
CONCLUSIONS
There is a paucity of literature on functional outcomes after surgical management of pediatric acute posterior SCFD. Functional outcomes after surgery were satisfactory in this cohort with most patients being able to perform major activities of daily living. Additional future studies with larger cohorts and comparative groups are needed to better understand outcomes in this population.
LEVEL OF EVIDENCE
METHODS
Level IV.
Identifiants
pubmed: 33017335
doi: 10.1097/BPO.0000000000001691
pii: 01241398-202101000-00006
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
11-16Références
Kendal JK, Thomas K, Lo IKY, et al. Clinical outcomes and complications following surgical management of traumatic posterior sternoclavicular joint dislocations: a systematic review. JBJS Rev. 2018;6:e2.
Tepolt F, Carry PM, Heyn PC, et al. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med. 2014;42:2517–2524.
Gil-Albarova J, Rebollo-González S, Gómez-Palacio VE, et al. Management of sternoclavicular dislocation in young children: considerations about diagnosis and treatment of four cases. Musculoskelet Surg. 2013;97:137–143.
Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg. 2011;19:1–7.
Ting BL, Bae DS, Waters PM. Chronic posterior sternoclavicular joint fracture dislocations in children and young adults: results of surgical management. J Pediatr Orthop. 2014;34:542–547.
Chaudhry S. Pediatric posterior sternoclavicular joint injuries. J Am Acad Orthop Surg. 2015;23:468–475.
Laffosse JM, Espié A, Bonnevialle N, et al. Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants. J Bone Joint Surg Br. 2010;92:103–109.
Waters PM, Bae DS, Kadiyala RK. Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents. J Pediatr Orthop. 2003;23:464–469.
Goldfarb CA, Bassett GS, Sullivan S, et al. Retrosternal displacement after physeal fracture of the medial clavicle in children. J Bone Joint Surg Br. 2003;83:1168–1172.
Kocher MS, Bae DS, Lee JT, et al. Posterior sternoclavicular joint injuries in skeletally immature patients. J Pediatr Orthop. 2013;34:369–375.
Swarup I, Hughes MS, Cazzulino A, et al. Open reduction and suture fixation of acute sternoclavicular fracture-dislocations in children. JBJS Essent Surg Tech. 2020;10:e19.00074.
Fenig M, Lowman R, Thompson BP, et al. Fatal posterior sternoclavicular joint dislocation due to occult trauma. Am J Emerg Med. 2010;28:385.e5–385.e8.
Southworth S, Merritt T. Asymptomatic innominate vein tamponade with retromanubrial clavicular dislocation. A case report. Orthop Rev. 1988;17:789–791.
Kennedy J. Retrosternal dislocation of the clavicle. J Bone Joint Surg Am. 1949;31B:74.
Wasylenko M, Busse E. Posterior dislocation of the clavicle causing fatal tracheoesophageal fistula. Can J Surg. 1981;24:626–627.
Ege T, Canbaz S, Pekindil G, et al. Bilateral retrosternal dislocation and hypertrophy of medial clavicular heads with compression of brachiocephalic vein. Int Angiol. 2003;22:325–327.
Nakayama E, Tanaka T, Noguchi T, et al. Tracheal stenosis caused by retrosternal dislocation of the right clavicle. Ann Thorac Surg. 2007;83:685–687.
Garg S, Alshameeri ZA, Wallace WA. Posterior sternoclavicular joint dislocation in a child: a case report with review of literature. J Shoulder Elb Surg. 2012;21:e11–e16.
Van Hofwegen C, Wolf B. Suture repair of posterior sternoclavicular physeal fractures: a report of two cases. Iowa Orthop J. 2008;28:49–52.
Ngom G, Mohamed AS, El Housseine MO, et al. Traumatic posterior sternoclavicular joint dislocation in a child: a case report. Pan Afr Med J. 2014;19:271–273.
Lehnert M, Maier B, Jakob H, et al. Fracture and retrosternal dislocation of the medial clavicle in a 12-year-old child—case report, options for diagnosis, and treatment in children. J Pediatr Surg. 2005;40:e1–e3.
Özer UE, Yalçin MB, Kanberoglu K, et al. Retrosternal displacement of the clavicle after medial physeal fracture in an adolescent: MRI. J Pediatr Orthop B. 2014;23:375–378.
Tepolt F, Carry PM, Taylor M, et al. Posterior sternoclavicular joint injuries in skeletally immature patients. Orthopedics. 2014;37:174–181.