Functional Outcomes Following Nonoperative Versus Operative Treatment of Clavicle Fractures in Adolescents

Abstract

Purpose Superiority of non-operative versus operative treatment of clavicle shaft fractures remains unclear. We aimed to assess shoulder function in adolescents following shortened clavicle fracture and compare operative versus non-operative treatment.Methods Patients aged 12 to 18 years at the time of fracture and minimum 1.5 years post injury were identified for this institutional review board (IRB)-approved study. For this retrospective cohort study, patients were frequency-matched for age, gender, shortening of the clavicle fracture and activity level. The dominant arm was controlled in the statistical model. Initial radiographs were used to measure clavicle shortening. At follow-up, isokinetic testing of both shoulders was performed in flexion, external rotation and the plane of scapular motion. Maximum number of isotonic repetitions and average isometric torque were recorded, as were ASES and DASH scores. Data were analysed comparing Results Twenty patients were recruited (18 male, 2 female), with ten in each group. Median clavicle shortening was 17.5 mm (11.4 to 23.6). There was no statistical difference in average ASES (100 vs 99; p = 0.84) or DASH (0.0 vs 1.7; p = 0.08) between non-operative and operative groups, respectively. Results of isokinetic testing comparison between non-operative and operative groups showed no statistical difference for any individual association, controlling for the dominant arm. Among the non-operative group, the involved arm had decreased functional measures compared with the uninvolved arm on all measures, when controlling for dominant arm, and there was increased variability of the functional estimate.Conclusions The increased variability in functional measures for the non-operative group suggests some patients may have dysfunction.Cite this article: Herzog MM, Whitesell RC, Mac LM, Jackson ML, Culotta BA, Axelrod JR, Busch MT, Willimon SC. Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents.

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

“…Finally, seven studies were deemed eligible for the synthesis of the quantitative data [1,3,4,[17][18][19][20]. The seven studies included a total of 522 patients (with 528 mid-diaphyseal clavicle fractures) with an age range of 8 to 18 years, 148 underwent operative management, and 380 underwent nonoperative management.…”

“…The study characteristics are depicted in Table 1. Across the 6 studies that reported gender, there were 335 males and 109 females [3,4,[17][18][19][20]. Patients were followed up from 2 weeks to 3.7 years across five studies that reported follow-up time [1,3,4,19,20].…”

“…Across the 6 studies that reported gender, there were 335 males and 109 females [3,4,[17][18][19][20]. Patients were followed up from 2 weeks to 3.7 years across five studies that reported follow-up time [1,3,4,19,20]. Across the 6 studies reporting displacement, all fractures were displaced in the operative group, and 221 out of 369 fractures were displaced in the non-operative group [1,3,4,17,18,20].…”

Closed midshaft clavicle fractures

“…With regard to the adolescent population, the existing body of evidence is insufficient to support the use of routine operative management. Although there is some evidence to support an earlier return to function, 6,31 the largest study reviewed indicated that there was no benefit observed with operative intervention. 23 Regarding adult fractures, it is difficult to interpret the apparently contradictory findings contained in the literature over the last two decades.…”

“…Herzog et al 31 conducted a retrospective study on 20 patients. The patient cohort was followed from the time of their injury for a year and a half.…”