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Is surgery the best treatment of clavicle fractures in adolescents?

Clavicle fractures are common in both adults and adolescents. Many heal with non-operative treatment without any sequel, but there are patients who may benefit from an operative intervention.

The discussion goes around an optimal treatment of a midshaft clavicle fracture if there is a significant displacement, comminution or shortening of the fracture in adolescents.

According to the study published by Jornal of Children’s Orthopedics (JCO), recent reviews have indicated that improved functional outcomes are achieved after open reduction and internal fixation of the clavicle – for example, McKee et al examined 111 adolescents with midshaft clavicle fractures treated by traditional non-operative treatment and open reduction and internal fixation with a plate. Conclusions found superior results of operative fixation than non-operative method, with superior surgeon-based (Constant Shoulder score) and patient-based (disabilities of the arm, shoulder and hand (DASH) score) outcome measure at every time-point in the study. Patients, who underwent operative fixation, had an earlier return to normal fixation.

At the same time, a multicenter randomized controlled trial performed in Canada also suggested that operative fixation of displaced clavicle shaft fractures resulted in Constant Shoulder score and DASH scores among patients compared with non-operative treatments. The literature on this topic for children and adolescents remains a little less clear.

Another study found out that adolescents who underwent operative fixation of closed midshaft clavicle fracture had shorter time to union and low complication rates. Patients who took the other way around – non-operative fixation – were more likely to report subjective complaints related to malunion, particularly those with increased shortening. These studies suggested no subjective or functional deficit among adolescent patients who have suffered a previous displacement or shortening followed by midshaft clavicular fracture.the main objective of this study, published on JCO, was to assess shoulder function and patient-reported physical functioning outcomes in children and adolescents by following clavicle fractures.

PeekMed allows you to manipulate the image in 3D environment and the surgeon is better able to anticipate possible complications and experiment with different approaches:

On this study, researchers  went deeper by comparing patients who were presented with clavicle shortening and underwent operative intervention with the ones presented with clavicle shortening  that opted for a non-operative intervention. In comparison with the operative and non-operative groups, as well as the injured and uninjured arms within patients.

Results have suggested that there is no difference in objective function or subjective patient-reported physical functioning outcome between operatively and non-operatively. Isokinetic testing (a commonly utilized tool for the assessment of muscular strength in orthopedic and sports medicine) also suggests that there is an increased variability in functional measurements for the involved arm compared to the uninvolved arm among patients treated non-operatively.

Patients who were treated non-operatively may have decreased function in the involved arm and patients treated operatively found more stability, objective functional outcome in the involved arm compared with the uninvolved arm.

PeekMed, for example, is a system that offers the possibility to measure the clavicle angle in less than 10 seconds. Check it now:

 

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