Clavicle fracture at children – a widespread trauma which takes the third place on frequency after fractures of a shoulder and forearm. Usually falling on a hand or squeezing of a thorax becomes the reason. Less often the change arises at blow in a clavicle. At children of younger age podnadkostnichny changes, at patients of the senior and average age groups – complete fractures are observed. The complete fracture is followed by sharp pain, deformation and hypostasis . At podnadkostnichny changes deformation is absent, pains insignificant. The diagnosis is exposed on the basis of yielded survey and results of a X-ray analysis. Treatment is usually conservative, various fixing bandages are used, if necessary the repozition is carried out. Operation is shown at the ineradicable shift of otlomk and threat of development of complications.
Clavicle fracture at children
The clavicle fracture at children makes 7,4-14% of total number of changes. It can be observed at any age, however the greatest number of cases is the share of age 2-4 years. Usually is the isolated trauma and arises in life or during the sports occupations. The combination to fractures of other bones and injuries of soft fabrics is observed seldom, as a rule – at road accident or falling from height.
Incomplete (podnadkostnichny) changes can remain not distinguished or to be diagnosed late because of poor symptomatology. Clavicle fractures, both incomplete, and full well grow together and do not leave behind functional frustration.
The clavicle fracture reasons at children's age
At children clavicle fractures arise owing to an indirect trauma more often: squeezings of a thorax or falling on a hand. The change is usually localized on border between external and average parts of a clavicle as in this place the bone is thinner, and its curvature is stronger expressed.
The direct trauma (blow on ) is observed rather seldom. In similar cases the change usually arises in an external part of a clavicle.
Features of a fracture of clavicle at children
Patients of younger age have breaks or podnadkostnichny changes more often. In traumatology such damages are called changes as "a green branch" as in a similar case there is the same that in attempt to break a young branch of a tree: an internal part of a bone breaks, and external (periosteum) remains whole and holds the broken ends, without allowing them to move. Usually such changes cross. In certain cases the otlomk withheld by a periosteum can be displaced a little at an angle.
At children of advanced age complete fractures of a clavicle which can be cross, slanting or splintered are observed. Degree of shift of otlomk can significantly vary. Because of the weight of an extremity and action of muscles at shift the typical picture is observed: central it is displaced up and back, and peripheral – down and forward.
Open fractures of a clavicle are observed very seldom. Usually they are again open as arise owing to perforation of skin a bone otlomk.
Clavicle fracture symptoms at children
At a podnadkostnichny change small or moderate hypostasis is observed, bruises in the place of a trauma sometimes develop, however the pain syndrome is usually not expressed. The child does not complain therefore parents sometimes take such trauma for a usual bruise and address the traumatologist only 1-2 weeks when on the place of a change the noticeable bone callosity which looks as a dense swelling is formed later.
At a complete fracture there is sharp pain, there is a hypostasis which was more expressed at the shift of otlomk. Nadplechye on the party of a change looks shortened. The patient adopts the characteristic compelled provision: inclines a trunk in the damaged party, holding a sore hand and pressing it to the lower part of a breast or a stomach.
The shovel on the party of a change "droops", its edges become more noticeable. The top extremity is developed knutr and displaced kpered. At a palpation the ends of otlomk are probed, the palpation is painful, the krepitation is sometimes noted. The movements are limited. The maximum morbidity is observed in attempt to raise a hand up through the party.
Clavicle fracture complications at children's age
At the expressed shift of otlomk injury of a subclavial artery, subclavial vein, branches of a humeral nervous texture, a pleura and a top of a lung is possible.
At damage of vessels symptoms of internal blood loss are observed: pallor of skin, weakness, cold sweat. At damage of branches of a humeral texture there are neurologic violations. Injury of a lung and pleura is followed by respiratory frustration.
In all listed cases urgent surgical intervention is necessary.
Diagnosis of a fracture of clavicle at children
For confirmation of the diagnosis the clavicle X-ray analysis in standard direct laying is appointed. Usually diagnosis does not cause difficulties. In difficult differentiable cases the computer tomography or a magnetic and resonant tomography of a clavicle can be appointed.
At emergence of suspicion on damage of vessels, nerves, pleura and lungs consultation of the vascular surgeon, children's neurosurgeon or thoracic surgeon is necessary. At suspicion on a rupture of a lung the thorax X-ray analysis in a direct projection is carried out.
Treatment of a fracture of clavicle at children
At a pre-hospital stage it is necessary to give to the child anesthetic and to provide to a hand rest, having bent it in an elbow and having suspended on a kosynochny bandage. It is also possible to bandage a hand to a trunk. If a change open, it is necessary to apply a sterile bandage a wound.
It is impossible to make independent attempts of reposition of otlomk – such actions can cause injury of skin, vessels and nerves. The patient needs to be transported strictly in a sitting position.
The children's traumatologist is engaged in treatment of fractures of clavicle. Treatment is usually carried out on an outpatient basis. The indication for hospitalization in injuries. the office is the considerable shift of otlomk, an open change, damage or threat of damage of an easy and neurovascular bunch and threat of perforation of skin.
At podnadkostnichny changes and complete fractures with small shift Delbe's rings or Dezo's bandage are imposed.
At changes with shift the repozition is made. At small children manipulation is carried out under the general anesthesia. At patients of advanced age local anesthesia can be applied. To eliminate shift on length, both strongly take away kzad and up. For a repozition of changes with angular shift and cross changes use special manual receptions (the doctor in a special way presses fingers on otlomk). After reposition the special fixing bandage is applied. The type of a bandage is chosen taking into account features of shift.
Terms of an immobilization are defined by a type of a change and age of the patient and usually make 2-3 weeks.
Expeditious treatment is required very seldom. The indication to operation is the open change, damage of vessels, nerves, a pleura and lung, threat of damage of the listed anatomic educations or threat of perforation of skin, and also considerable shift of otlomk which cannot be eliminated during a repozition.
Surgical intervention is carried out under the general anesthesia. If the change is localized in a middle part of a clavicle, the clavicle osteosynthesis a pin or spokes is possible. Use also special S-shaped plates and usual reconstructive plates. At damages of the akromialny end of a clavicle the clavicle osteosynthesis by a plate with the blocking screws or a hook-shaped plate is usually carried out.
The forecast is favorable. The movements remain in full. At an adequate repozition of otlomk the normal configuration of a clavicle is restored within several months.