Clavicle fractures in children

The clavicle is the main channel connecting the upper limbs to the torso. The structure can support our neck and cervical spine. If there is a problem with the clavicle, it means that the patient may be greatly affected and may even be unable to support his or her own body. When a child has a clavicle fracture, it is important to be aware of these precautions.

1 The clavicle is the only bony structure connecting the upper limb girdle to the trunk. From the perspective of biomechanics, the forces acting on the clavicle during movement include: the clavicle extends and retracts around the vertical axis through the costoclavicular ligament in the cross section; the clavicle rises and descends around the sagittal axis through the costoclavicular ligament in the coronal plane; and the clavicle rotates around its longitudinal axis. The clavicle supports the scapula, keeping the scapula at a certain distance from the thorax to ensure flexible movement of the upper limbs. After a clavicle fracture, non-surgical treatment that restricts shoulder joint movement can lead to shoulder dysfunction. For unstable clavicle fractures, slight shoulder joint movement can cause relative movement between the clavicle ends, and even fracture re-displacement, leading to clavicle shortening, malformed fracture healing, and thickening of the fracture site affecting the appearance. Therefore, unstable clavicle fractures require reliable fixation.

2 Advantages of Ni-Ti memory alloy internal fixator in the treatment of clavicle fracture

1Compared with conventional Kirschner wire fixation

There are many surgical treatments for clavicle fractures. The traditional method in China is Kirschner wire fixation, but Kirschner wire fixation is prone to loosening and slipping, with a slippage and loosening rate as high as 12% to 17% [2, 3]. After intramedullary fixation of comminuted fractures with Kirschner wires, additional steel wires, thick silk threads or absorbable sutures are often required [4]. A single Kirschner wire does not have the function of controlling rotation. The broken ends may move slightly after surgery, and the steel wire may easily slip into the clavicle fracture fragments, causing failure of internal fixation and nonunion or malunion of the fracture. The author has encountered two cases of this. The risk of closed pinning of clavicle fractures is relatively high, as it can easily injure blood vessels, nerves or pleura. Open reduction is generally used, but open reduction and internal fixation can damage the medullary cavity and periosteum, which is not conducive to fracture healing.

Ni-Ti memory alloy internal fixator provides a new treatment method without damaging intramedullary tissue. The 2/3 arc-shaped circular arm design is more suitable for comminuted fractures and does not require external wire fixation. The main plate of the internal fixator is placed on the upper edge of the clavicle. The clinical treatment method is simple, does not require drilling, avoids complications caused by drilling, has a short operation time and little trauma. Due to the characteristics of the memory alloy itself, the embracing effect always exists, and the serrated edge can effectively prevent rotation. Therefore, the memory alloy internal fixator has a good anti-torsion effect.