当院における若年者鎖骨遠位端骨折手術症例の検討

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We performed surgical treatments on severely displaced distal clavicle fractures of 3 young patients under 15 years old who appeared in our hospital between April 2007 and March 2010. Case 1: Five-year old female with a severely displaced distal clavicle fracture underwent an open pin fixation at 15 days after the injury due to poor callus formation and extended displacement. Case 2: Fourteen-year old male with a severe distal physeal injury underwent an open pin fixation. Case 3: Fifteen-year old male with a severe distal clavicle fracture underwent a tension band wire fixation. We could see all the patients achieved bone union without residual deformity, pain, limited range of motion, or muscle weakness at the final examinations. Adult distal clavicle fractures of Neers type II are generally treated surgically. We may perform a surgery on a young patient with such an injury if epiphyseal growth is already arrested. However, a surgical indication for young patients with severely displaced distal clavicle fractures is still controversial. Kwon et al. recommended a surgery for those with Rockwoods types IV, V, or VI. On the other hand, Black et al. demonstrated excellent results of conservatively treated skeletally immature patients with injuries to the distal clavicle. As for conservatively treated distal clavicular physeal injury, Havranek suggested an open reduction and internal fixation for some of those with great displacement that led to residual deformity, and Ogden presented a case that necessitated resection of the displaced and deformed original distal clavicle. The present 3 cases attributed to the type IV or V and the immobility was so severe even under general anesthesia, which we thought indicated a surgical treatment as an option. We conclude that a young patient with a severely displaced distal clavicle injury may possibly require surgery.

当院における若年者鎖骨遠位端骨折手術症例の検討

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