Complications in the Treatment of Adolescent Clavicle Fractures

Abstract

The authors’ study evaluates the complications associated with the treatment of clavicle fractures in adolescents. During the study period, 153 clavicle fractures occurred in patients between the ages of 14 and 17 years who were treated at the authors’ center, of which 23 (15.0%) were treated surgically. Compared to the fractures treated nonoperatively, the surgical fractures had greater shortening (mean, 2.0 vs 0.9 cm; P<.001) and were more likely to be comminuted (65.2% vs 23.1%; P<.001). Complications occurred in 21.7% of fractures treated surgically. One delayed union occurred in the nonoperative cohort, but no other complications or patients who required clavicular osteotomy for malunion. Pediatric fellowship-trained orthopedic surgeons treated 78 displaced fractures, resulting in 8 (10.3%) surgeries. Nonpediatric orthopedic specialists treated 46 displaced fractures, 15 (32.6%) of which were treated operatively (P=.0035). FigureA 15-year-old boy sustained a comminuted clavicle fracture from playing football. Preoperative radiograph showing significant clavicle shortening and a vertical fragment.

Surgical management of displaced midshaft clavicle fracture in skeletally immature patient- What is the evidence?

“…One of the studies was excluded as it didn't report the outcome of surgical fixation [8]. Table 1 shows the details of the included studies [1,11,12,[14][15][16][17][18]. All but one study [16] were retrospective series.…”

“…If studies presented data on acute midshaft fractures mixed with lateral or medial, the results for acute midshaft fractures were extracted. Complication is defined as any adverse event requiring further treatment [1].…”

“…The clavicle is the most commonly fractured bone in children which accounts for 10%-15% of all paediatric fractures [1]. Midshaft clavicle fractures are the most common, including 80% of fractures [1].…”

“…Although the principles of surgical treatment of clavicle fractures in adults may not be quite applicable to the paediatric population due to high healing and remodelling potentials [1,5,[10][11][12].…”

“…Midshaft clavicle fractures are the most common, including 80% of fractures [1]. The annual incidence is about 25 fractures per 10,000 children younger than 19 years [2].…”