Pediatric Clavicle and Acromioclavicular Injuries

Shah, Rohan J.; Kinder, Jeremy M.; Peelman, J.; Moen, Todd C.; Sarwark, John F.

doi:10.1097/bpo.0b013e3181ba9e94

Cited by 18 publications

(13 citation statements)

References 15 publications

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“… 7 The clavicle is the most commonly fractured bone in both adults and children, 1 , 4 , 11 , 13 accounting for 5% to 15% of all fractures and 35% to 44% of those in the shoulder region. 22 , 28 - 30 Approximately 85% of pediatric clavicle fractures result from sports or recreational activities, 31 and they are among the most common fractures in adolescents. 28 …”

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confidence: 99%

Surgical Treatment of Clavicle Fractures in the Adolescent Athlete

2015

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Context:Current literature has clearly shown that the indications for surgical treatment of clavicle fractures in adults are expanding. Although clavicle fractures in children and adolescents have traditionally been treated nonoperatively, surgical treatment of displaced clavicle fractures may be indicated for adolescent athletes.Evidence Acquisition:A review of relevant articles published between 1970 and 2013 was completed using MEDLINE and the terms clavicle fracture and adolescent athlete.Study Design:Clinical review.Level of Evidence:Level 3.Results:Excellent outcomes and rapid return to competition can be achieved with surgical management of displaced clavicle fractures in the adolescent athlete with high functional demands similar to those of their adult counterparts. Complications include hardware irritation, screw loosening, pin migration, peri-incisional numbness, and refracture. Athletes and families must be counseled regarding complications and potential need for secondary surgery to remove hardware.Conclusion:The adolescent athlete with a displaced, shortened, or comminuted clavicle fracture presents a unique, controversial dilemma for the surgeon. Earlier return to competition can be achieved with surgical management to restore length and alignment and may prevent malunion, nonunion, and poor outcomes.

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Surgical Treatment of Clavicle Fractures in the Adolescent Athlete

2015

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“…There was as much as 10% more growth after the age of 18 years in male subjects and as much as 6% in female subjects. Previous literature has reported that in a normal clavicle, 80% of longitudinal growth occurs from the medial physis [16, 24] and that the medial physis does not fuse until 23 to 25 years of age [9, 16, 18]. An open physis and the fact that the physis contributes substantially to fracture remodeling in other long bones suggest that even after 18 years of age, there is still remodeling potential for clavicle fractures [1, 21, 22].…”

Section: Discussionmentioning

confidence: 99%

“…McGraw et al provide the most comprehensive study to date on clavicular growth [12], although several surgeon–investigators have observed significant fracture remodeling even in older adolescents, perhaps a result of greater clavicular growth in such patients than had previously been reported [17]. Furthermore, it is estimated that 80% of the longitudinal growth of the clavicle occurs from the medial physis [16, 24] and that the medial epiphysis does not complete ossification until about 20 years of age and does not fully fuse until 23 to 25 years of age [9, 16, 18]. Given that the upper age limit in the analysis by McGraw et al was 18 years, it is possible that the full remodeling potential of the clavicle has not yet been appreciated.…”

Section: Introductionmentioning

confidence: 99%

The Clavicle Continues to Grow During Adolescence and Early Adulthood

et al. 2020

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Background As more adults undergo surgical fixation of clavicle fractures with improved outcomes, interest is renewed in managing clavicle fractures in adolescents. The medial clavicular physis does not fuse until 23 to 25 years of age, but studies report minimal clavicular growth during adolescence—studies that employed cross-sectional methodologies, which cannot not capture growth in patients over time. The assumption that clavicle length at each stage is uniform, as is the final overall length, may not be accurate if the age groups studied comprise various ethnicities, socioeconomic status, or height. Questions/Purposes We sought to quantify longitudinal clavicular growth on serial radiographs in adolescents and young adults. Our hypothesis was that substantial clavicular growth would be seen beyond the age of 12 years. Methods We conducted a longitudinal case series of non-syndromic patients in a single orthopedic clinic and analyzed serial radiographic images of the clavicles. For ethical reasons, only patients with non-neuromuscular scoliosis and kyphosis (in whom the existing standard of care includes serial thoracic radiographs) were considered for inclusion. Patients ages 10 to 25 years old were included in the study if three or more serial thoracic radiographs over a minimum 5 years were available that captured the entire length of at least one non-rotated clavicle. Three types of radiographs were included for analysis: digital low-dose-radiation stereoradiographic (EOS Imaging, Paris, France), non-EOS digital, and non-EOS printed. The overall longitudinal growth, yearly growth, and the yearly growth percentage were calculated for each clavicle. Results Fifty-seven patients (22 male and 35 female) met the inclusion criteria. In male patients, at ages 12 to 15 years, the clavicular growth was 4.9 mm/year, or 4%/year; at ages 16 to 19 years, growth was 3.2 mm/year, or 2.4%/year; and at ages 20 to 25 years, growth was 1.7 mm/year, or 1.1%/year. In female patients, at ages 12 to 15 years, growth was 4.7 mm/year, or 4%/year; at 16 to 19 years, growth was 2.2 mm/year, or 1.7%/year; and at ages 20 to 25 years, growth was 0.2 mm/year or 0.1%/year. We could not detect the age of terminal growth in either sex because growth was ongoing in most patients in the oldest group. Conclusion We found substantial clavicular growth potential after age 18 years, when growth is thought to be nearly finished, as well as remodeling potential even up to age 25 years. Further research is needed, but our findings suggest that strategies for managing clavicle fracture in adults may not be applied universally to adolescents and young adults.

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“…However, they are rare injuries in the distal region, where they account for only 10–20% of all fractures of the clavicle. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

“…3 , 4 Fractures of the distal third of the clavicle are generally caused by direct trauma on the shoulder, and approximately 85% result from injuries during sports or recreational activities. 2 Given that the center of ossification of the distal epiphysis of the clavicle appears after the age of 18 years and the medial fragment of the clavicle may become avulsed from the periosteum (which both have great potential for remodeling), significant shoulder deformities may develop in children. 3…”

Section: Introductionmentioning

confidence: 99%

Distal clavicle fractures in children

Labronici

Silva

Franco

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo analyze fractures of the distal clavicle region in pediatric patients.MethodsTen patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system.ResultsAll the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture.ConclusionThe treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments.

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Pediatric Clavicle and Acromioclavicular Injuries

Cited by 18 publications

References 15 publications

Surgical Treatment of Clavicle Fractures in the Adolescent Athlete

Surgical Treatment of Clavicle Fractures in the Adolescent Athlete

The Clavicle Continues to Grow During Adolescence and Early Adulthood

Distal clavicle fractures in children

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