Functional and Radiographic Outcomes of Nonoperative Treatment of Displaced Adolescent Clavicle Fractures

Abstract

Regardless of patient age, sports participation, and final clavicle shortening, no differences in pain, strength, shoulder range of motion, or subjective outcome scores were found between the injured and uninjured limbs of adolescents treated nonoperatively for a displaced, shortened, midshaft clavicle fracture.

Is There a Deficit After Nonoperative Versus Operative Treatment of Shortened Midshaft Clavicular Fractures in Adolescents?

“…11,13,[17][18][19]32 In this study, 2 (25%) of the 8 operatively treated fractures required hardware removal. No symptomatic malunions or nonunions developed in the 8 nonoperative patients or the entire original cohort (124 adolescents) demonstrating the inherent healing potential and good outcomes associated with this injury in the adolescent age group.…”

“…No visual feedback was provided. These positions of the glenohumeral joint were chosen during MVIC measurement to be able to better compare our results with those found by Schulz et al 18 Stoughton, MA). [27][28][29][30] Testing was performed in a sitting position with the shoulder abducted to 10 to 20 degrees in the scapular plane, the elbow flexed to 90 degrees, and the forearm pronated.…”

“…Before the study a power analysis was performed using the data from Schulz et al 18 to have sufficient power (80%) to detect a 10% difference in abduction strength between treatment groups a sample size of 70 patients would be necessary. Therefore we set out to perform a pilot study with 16 patients.…”

“…However, Vander Have et al 13 recently reported that surgical fixation resulted in faster healing and return to unrestricted activities, whereas 20% of the conservatively treated adolescents in the series developed symptomatic malunions. 11,17,18 Two other recent studies evaluated shoulder range of motion, strength, and fatigue in adolescents treated conservatively and found mild deficits of questionable clinical relevance. 17,18 The purpose of this study is to determine whether deficits in subjective or objective upper extremity function occur after nonoperative versus operative management of displaced, shortened clavicle fractures in adolescents.…”

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

“…The current evidence on surgical management of paediatric clavicle fractures is limited [8, [12][13][14][15]. The purpose of this study is to perform a systematic review of surgical treatment of displaced midshaft clavicle fracture in skeletally immature patients focusing on the outcome and complication profile of surgically treated fractures.…”