A review of the current literature has shown that the best conservative management of paediatric clavicle shaft fractures is controversial. Although there are publications showing that most surgeons working in the United States prefer to use a simple arm sling to conservatively treat their patients
10, it has been concluded that orthopaedic surgeons in Germany prefer eight bandages in 88% of cases in the conservative treatment of clavicle fractures
11. In the literature, simple arm sling and eight bandage have been widely used in the treatment of these fractures, but studies on the use of velpeau bandage, which provides better early pain control, is easier to use and is associated with fewer complications, are limited
12.
In our study, we observed that the results of all 3 methods were satisfactory and reliable. It was observed that simple arm sling and velpeau bandage were more preferred in patients with less fracture displacement at the beginning, earlier pain control was achieved in patients treated with velpeau bandage, bandage-related complication rates were lower in velpeau bandage method, and shortening of the clavicle in the 1st year after treatment did not affect the functional results in patients selected within certain criteria. Although the advantage of the eight bandage, which is more prefer-red in depressed fractures, was more beneficial in pre-venting clavicle shortening at 1 year, we observed that all 3 methods had similar results in PASS scores at 6 weeks and 1 year, VAS pain scores were higher in the first weeks in patients treated with the eight bandage compared to other methods, and bandagerelated problems were more common. Our study is important in terms of guiding the confusion experienced by emergency physicians and even orthopaedists when choosing bandage methods used in the conservative treatment of clavicle fractures. In addition, it is one of the limited number of studies evaluating the clinical results of patients treated with 3 different bandage types and examining the effectiveness of the length differences in the clavicle on the shoulder functions of the patients.
In the literature, meta-analyses have reported that both surgical and conservative treatment of displaced middle third clavicle fractures have good functional results13. Although eight bandages and shoulder-arm slings are frequently used among conservative treatments for clavicle fractures, there are few studies comparing the superiority of both methods8. There are publications suggesting that the application of eight bandages is more difficult than arm sling, patients feel more pain in the first days, and the use of arm sling is recommended because of these disadvantages8. In our study, when the 1st day and 1st week VAS pain scores of the patients were analysed, it was observed that the best pain control method was the velpeau bandage, followed by the simple arm sling method, and the worst pain cont-rol method was the eight bandage. In addition, when the complications related to the bandaging method were analysed, similar results were found with the pain score.
In the conservative treatment of clavicle fractures in the paediatric age group, post-treatment functional scoring and clinical results were similar between shoulderarm sling and eight bandages14. Although VAS pain score, DASH15 and Constant score16 were used to measure clinical outcomes in most of the similar studies in the literature, the Turkishised PASS score (Figure 3) and VAS pain score scales, which were developed more specifically for paediatric patients and consisted of relatively easier questions, were used in our study. The PASS score was preferred because it gives more reliable results17,18 for investigating the clinical outcomes of shoulder lesions in paediatric patients compared to other upper extremity scoring scales such as Constant and DASH scores.
In the literature, primarily conservative treatment is recommended for children younger than 10 years of age and the success of treatment in these children is reported to be high regardless of the type of immobilisation. In clavicle fractures, it has been reported that fractures displaced less than 20 mm are suitable for conservative treatment and more displaced fractures should be treated surgically19.
In our study, union was observed in patients who were treated conservatively within the framework of the specified criteria and no complication developed in 85.4% of these patients. Problems related to the banda-ging method were observed in 14.6% of the patients who were followed up conservatively, but these prob-lems did not affect the union result. When the VAS pain scores of all patients decreased to 0 or 1, bone bridge was formed on plain radiographs, and pain complaints disappeared, the fracture was considered to have fused and the bandaging method was disconti-nued. There was no statistically significant difference between the 3 methods used in terms of discontinuation of bandage use (p>0.05) and complete union was ob-served in all patients.
There are publications reporting that surgical indications for shortening resulting from paediatric clavicle fractures should be reviewed and good results were observed despite shortening and initial fracture displacement20. In our study, it was observed that the shortening seen in the simple arm sling and velpeau bandage was not reflected in the PASS scores at the 6th week and 1st year compared to the patients treated with the eight bandage with relatively less shortening.
In addition to the common opinion in the existing literature, when the long-term results of conservative treatment of clavicle fractures in adolescents were analysed, it was reported that the patient-reported results were excellent and nonunion was very rare, but shortening of the fracture may have a small negative effect on the result21. In another study, it was reported that the shortening of the clavicle length after treatment did not change the functional results of the patient and did not affect social activities such as participation in sports22.
In our study, only patients with fracture displacement less than 15 mm at the beginning were included in the study in order to evaluate the effectiveness of bandage methods more accurately. The change in the clavicle lengths of these patients after treatment was not reflected on the functional results when the PASS scoring of the patients in the 1st year was analysed and our results are compatible with the literature.
This study has some limitations. The first one is the retrospective design of the study and the small sample size and no evaluate muscle strength.
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