Descriptive Epidemiology of Adolescent Clavicle Fractures: Results From the FACTS (Function after Adolescent Clavicle Trauma and Surgery) Prospective, Multicenter Cohort Study

Abstract

Background: The majority of previous investigations on operative fixation of clavicle fractures have been related to the adult population, with occasional assessments of the younger, more commonly affected adolescent population. Despite limited prospective data for adolescents, the incidence of operative fixation of adolescent diaphyseal clavicle fractures has increased. Purpose: To detail the demographic features and descriptive epidemiology of a large pooled cohort of adolescent patients with diaphyseal clavicle fractures presenting to pediatric tertiary care centers in the United States through an observational, prospective, multicenter cohort study (Function after Adolescent Clavicle Trauma and Surgery [FACTS]). Study Design: Cross-sectional study; Level of evidence, 4. Methods: Patients aged 10 to 18 years who were treated for a diaphyseal clavicle fracture between August 2013 and February 2016 at 1 of 8 geographically diverse, high-volume, tertiary care pediatric centers were screened. Treatment was rendered by any of the pediatric orthopaedic providers at each of the 8 institutions, which totaled more than 50 different providers. Age, sex, race, ethnicity, fracture laterality, hand dominance, mechanism of injury, injury activity, athletic participation, fracture characteristics, and treatment decisions were prospectively recorded in those who were eligible and consented to enroll. Results: A total of 545 patients were included in the cohort. The mean age of the study population was 14.1 ± 2.1 years, and 79% were male. Fractures occurred on the nondominant side (56%) more frequently than the dominant side (44%). Sport was the predominant activity during which the injury occurred (66%), followed by horseplay (12%) and biking (6%). The primary mechanism of injury was a direct blow/hit to the shoulder (60%). Overall, 54% were completely displaced fractures, defined as fractures with no anatomic cortical contact between fragments. Mean shortening within the completely displaced group was 21.9 mm when measuring the distance between fragment ends (end to end) and 12.4 mm when measuring the distance between the fragment end to the corresponding cortical defect (cortex to corresponding cortex) on the other fragment (ie, true shortening). Comminution was present in 18% of all fractures. While 83% of all clavicle fractures were treated nonoperatively, 32% of completely displaced fractures underwent open reduction and internal fixation. Conclusion: Adolescent clavicle fractures occurred more commonly in male patients during sports, secondary to a direct blow to the shoulder, and on the nondominant side. Slightly more than half of these fractures were completely displaced, and approximately one-fifth were comminuted. Within this large cohort, approximately one-third of patients with completely displaced fractures underwent surgery, allowing for future prospective comparative analyses of radiographic, clinical, and functional outcomes.

Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled

“…The majority of patients with a clavicle fracture are male (91.2%), and most clavicle fractures are seen between the ages of 10 and 19 years (incidence rate of 91.7 per 100,000) [ 1 , 3 ]. Fractures on the left side (58%) and on the non-dominant side (56%) are slightly more common [ 4 ]. Most clavicle fractures occur in the middle section of the bone, accounting for 70% to 95% of all pediatric clavicle fractures [ 1 , 5 , 6 ].…”

“…Most clavicle fractures occur in the middle section of the bone, accounting for 70% to 95% of all pediatric clavicle fractures [ 1 , 5 , 6 ]. Displaced fractures of the clavicle are relatively common, ranging from 28% to 67% of all clavicle fractures in children and adolescents [ 1 , 4 , 6 , 7 ].…”

“…Clavicle fractures occur most frequently as a result of sports (66%), horseplay (12%), riding a bike (6%), a fall (6%) or another type of accident (3%) [ 4 ]. However, clavicle fractures may also occur during childbirth, particularly in the case of shoulder dystocia [ 8 , 9 ].…”

“…Most fractures are caused by blunt trauma to the shoulder or upper arm (60%), trauma to the clavicle or chest (24%) or a fall on an outstretched arm (11%) [ 4 ].…”

“…Clavicle fractures are often the result of trauma and can present as a deformity or open fracture, although visible deformity may also be absent [ 4 , 20 , 21 ]. The fracture is tender on palpation, and movement of the shoulder is labored, painful and sometimes limited [ 2 , 20 ].…”