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Fractures around the shoulder in the skeletally immature: A scoping review

Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be tre...

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Autores principales: Kraal, Tim, Struijs, Peter AA, Langenberg, Lisette C, van Bergen, Christiaan JA
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473910/
https://www.ncbi.nlm.nih.gov/pubmed/37662664
http://dx.doi.org/10.5312/wjo.v14.i8.604
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author Kraal, Tim
Struijs, Peter AA
Langenberg, Lisette C
van Bergen, Christiaan JA
author_facet Kraal, Tim
Struijs, Peter AA
Langenberg, Lisette C
van Bergen, Christiaan JA
author_sort Kraal, Tim
collection PubMed
description Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be treated conservatively. However, the key is to understand when a child benefits from surgical management. Clear indications for surgery of these fractures are lacking. This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children. The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures, tenting of the skin with necrosis, associated neurovascular injury, or a floating shoulder. There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic. In the rare case of a symptomatic malunion of the clavicle in children, corrective osteosynthesis is a viable treatment option. For proximal humerus fractures in children, treatment is dictated by the patient's age (and thus remodeling potential) and the amount of fracture displacement. Under ten years of age, even severely displaced fractures can be treated conservatively. From the age of 13 and onwards, surgery has better outcomes for severely displaced (Neer types III and IV) fractures. Between 10 and 13 years of age, the indications for surgical treatment are less clear, with varying cut-off values of angulation (30-60 degrees) or displacement (1/3 – 2/3 shaft width) in the current literature.
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spelling pubmed-104739102023-09-03 Fractures around the shoulder in the skeletally immature: A scoping review Kraal, Tim Struijs, Peter AA Langenberg, Lisette C van Bergen, Christiaan JA World J Orthop Minireviews Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be treated conservatively. However, the key is to understand when a child benefits from surgical management. Clear indications for surgery of these fractures are lacking. This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children. The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures, tenting of the skin with necrosis, associated neurovascular injury, or a floating shoulder. There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic. In the rare case of a symptomatic malunion of the clavicle in children, corrective osteosynthesis is a viable treatment option. For proximal humerus fractures in children, treatment is dictated by the patient's age (and thus remodeling potential) and the amount of fracture displacement. Under ten years of age, even severely displaced fractures can be treated conservatively. From the age of 13 and onwards, surgery has better outcomes for severely displaced (Neer types III and IV) fractures. Between 10 and 13 years of age, the indications for surgical treatment are less clear, with varying cut-off values of angulation (30-60 degrees) or displacement (1/3 – 2/3 shaft width) in the current literature. Baishideng Publishing Group Inc 2023-08-18 /pmc/articles/PMC10473910/ /pubmed/37662664 http://dx.doi.org/10.5312/wjo.v14.i8.604 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Minireviews
Kraal, Tim
Struijs, Peter AA
Langenberg, Lisette C
van Bergen, Christiaan JA
Fractures around the shoulder in the skeletally immature: A scoping review
title Fractures around the shoulder in the skeletally immature: A scoping review
title_full Fractures around the shoulder in the skeletally immature: A scoping review
title_fullStr Fractures around the shoulder in the skeletally immature: A scoping review
title_full_unstemmed Fractures around the shoulder in the skeletally immature: A scoping review
title_short Fractures around the shoulder in the skeletally immature: A scoping review
title_sort fractures around the shoulder in the skeletally immature: a scoping review
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473910/
https://www.ncbi.nlm.nih.gov/pubmed/37662664
http://dx.doi.org/10.5312/wjo.v14.i8.604
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