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Claviculaschaftfrakturen im Kindes- und Jugendalter

Konsensusreport der Sektion Kindertraumatologie in der Deutschen Gesellschaft für Unfallchirurgie

Clavicle shaft fractures in childhood and adolescence

Consensus report of the Pediatric Traumatology Section of the German Society for Trauma Surgery

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Zusammenfassung

Einleitung

Claviculaschaftfrakturen gehören zu den häufigsten Frakturen im Kindes- und Jugendalter. Früher wurden diese fast ausschließlich konservativ therapiert, in den letzten Jahren zeigte sich jedoch eine Zunahme der operativen Versorgungen. Klare Empfehlungen zur Diagnostik und zur Therapiewahl für diese Verletzung gibt es bisher nicht.

Material und Methoden

Ziel war deshalb, im Rahmen des 7. wissenschaftlichen Arbeitstreffens der Sektion für Kindertraumatologie in der Deutschen Gesellschaft für Unfallchirurgie einen Konsens auf Basis der Expertenmeinung zu erarbeiten.

Ergebnisse

Die Röntgendarstellung in einer Ebene gilt als Goldstandarddiagnostikum. Kinder unter 10 Jahren werden vornehmlich konservativ behandelt; die Art der Ruhigstellung ist zweitrangig. Bei Mädchen älter als 12 Jahre und Jungen älter als 14 Jahre sollten um mehr als Schaftbreite dislozierte und > 2 cm verkürzte Frakturen offen reponiert und osteosynthetisch stabilisiert werden, gefolgt von einer freifunktionellen Nachbehandlung.

Schlussfolgerung

Neben dem Röntgen gilt es, die Ultraschalldiagnostik weiter zu etablieren. Die Therapie erfolgt weiterhin vornehmlich konservativ, die operative Therapie hat jedoch ebenfalls einen Stellenwert, insbesondere bei Jugendlichen. Bei korrekter Indikationsstellung ist unabhängig von der Therapiewahl von einem guten Outcome auszugehen.

Abstract

Introduction

Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist.

Material and methods

Therefore, our aim was to develop a consensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion.

Results

Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10 years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12 years and boys older than 14 years, fractures dislocated by more than the shaft width and shortened by > 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment.

Conclusion

In addition to X‑rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, a good outcome can be expected regardless of the choice of treatment.

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Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland

    Ilona Schubert & Peter C. Strohm

  2. Universitätsklinikum Frankfurt: Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Deutschland

    Katharina Moers

  3. Kindertraumatologie, Klinikum Stuttgart Olgahospital, Stuttgart, Deutschland

    Francisco F. Fernandez

  4. Oberschwabenklinik Ravensburg, Ravensburg, Deutschland

    Jörn Zwingmann

  5. Kindertraumatologie und Kinderorthopädie, BG Unfallklinik Murnau, Murnau, Deutschland

    Dorien Schneidmüller

  6. Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    Peter P. Schmittenbecher

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  1. Ilona Schubert
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Sektion Kindertraumatologie in der DGU

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Correspondence to Ilona Schubert.

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I. Schubert, K. Moers, F.F. Fernandez, J. Zwingmann, D. Schneidmüller, P.P. Schmittenbecher und P.C. Strohm geben an, dass kein Interessenkonflikt besteht.

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Schubert, I., Moers, K., Fernandez, F.F. et al. Claviculaschaftfrakturen im Kindes- und Jugendalter. Unfallchirurgie 126, 244–251 (2023). https://doi.org/10.1007/s00113-022-01275-9

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