Fixation of Displaced Midshaft Clavicle Fractures in Skeletally Immature Patients

• Published in: Journal of pediatric orthopaedics Vol. 31; no. 5; pp. 507 - 511
• Main Authors: Namdari, Surena, Ganley, Theodore J, Baldwin, Keith, Rendon Sampson, Norma, Hosalkar, Harish, Nikci, Valdet, Wells, Lawrence
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-07-2011; Lippincott Williams & Wilkins
• Subjects: Adolescent; Biological and medical sciences; Child; Clavicle - diagnostic imaging; Clavicle - injuries; Clavicle - surgery; Diseases of the osteoarticular system; Female; Follow-Up Studies; Fracture Fixation, Internal - methods; Fracture Healing; Fractures, Closed - diagnostic imaging; Fractures, Closed - physiopathology; Fractures, Closed - surgery; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Radiography; Recovery of Function; Retrospective Studies; Shoulder - physiology; Surveys and Questionnaires; Time Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Human; Fracture dislocation; Fixation; Clavicle; ORIF; Orthopedics; Diseases of the osteoarticular system; midshaft clavicle fractures; closed; displaced; Bone; skeletally immature
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0b013e318220ba48

BACKGROUNDThere is ongoing debate in the adult literature regarding fixation of displaced, closed midshaft clavicle fractures. Functional outcomes of treatment of these fractures in skeletally immature patients have not been previously investigated.
METHODSWe retrospectively reviewed 14 skeletally immature patients with closed, displaced, midshaft clavicle fractures treated with open reduction internal fixation. Baseline data acquisition included demographic and radiographic indices. Follow-up data included radiographic and functional outcomes assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (QuickDASH), the simple shoulder test, and additional binary questions.
RESULTSMean age for operative patients was 12.9 years. There were 12 male and 2 female cases. Twelve patients had injuries to the dominant extremity. Twelve patients had initially been treated nonoperatively, but underwent surgery due to increased displacement at 3 weeks. Minimum follow-up was 24 months. Mean postoperative total QuickDASH score was 7.0. Patients had a mean of 11 questions answered “yes” for the simple shoulder test. Four patients from the operative group underwent a second surgical procedure to remove hardware. Eight (57%) patients complained of numbness at the site of injury/surgery. Preoperative mean fracture shortening and vertical displacement were 14.4 and 19.7 mm, respectively. Follow-up radiographs at mean 3 months demonstrated healed fractures in all cases. Multiple linear regression showed no difference in QuickDASH score after adjusting for age, sex, injury to dominant extremity, shortening, and percent displacement (P=0.220).
CONCLUSIONSIn conclusion, operative treatment of displaced midshaft clavicle fractures in skeletally immature patients resulted in high scores on commonly used instruments of outcomes assessment. Operative patients may require additional surgery to remove prominent or painful hardware and may be prone to numbness at the incision site.Level IV.