Conservative Management of Paediatric Clavicle Fractures

Abstract

Paediatric clavicle fractures have traditionally been treated nonoperatively. Recent studies have recommended operative management for displaced midshaft fractures. We conducted a retrospective review of all clavicle fractures in children aged one to sixteen over a two-year period. We classified fractures and evaluated followup and clinical outcome. We identified 190 fractures. There were 135 boys and 55 girls. 65% of fractures were displaced and 35% undisplaced. Mean radiographic and clinical followup was 35 days and 44 days, respectively. Clavicle fractures in children heal with nonoperative management. Radiographs of clavicle fractures in children are unnecessary in the absence of clinical symptoms.

Clavicle fractures

“…Complete displacement (no contact between fragments) of the fracture possibly increases by 3.2 times the risk of complication (Strauss et al, 2012). Older children have a higher risk of complications, possibly due to the increased number of displaced clavicular fractures with increasing pediatric age and the progressive changes in the bone stiffness and periosteum (O'Neill et al, 2011;Strauss et al, 2012). The location of the fracture (central, medial, or lateral) does not influence the rate of complication in this population (Strauss et al, 2012).…”

“…Most fractures, including physeal separations with intact periosteal sleeve, can be treated conservatively and will heal uneventfully (O'Neill et al, 2011;Herring and Texas Scottish Rite Hospital for Children, 2013). Recent trends in the literature suggest treating clavicle fractures with open reduction and internal fixation in the adolescent population, especially in the highly active teenagers (Pandya et al, 2012;Yang et al, 2015).…”

“…Recent trends in the literature suggest treating clavicle fractures with open reduction and internal fixation in the adolescent population, especially in the highly active teenagers (Pandya et al, 2012;Yang et al, 2015). Indications for surgical treatment include open fractures, skin tenting, neurovascular compromise, and complex fractures with extensive comminution (Strauss et al, 2012;O'Neill et al, 2011).…”

“…Growth disturbances, nonunion, malunion, and neurovascular injuries are rare complications (3.7%) with conservative treatment of pediatric clavicle fractures (O'Neill et al, 2011;Strauss et al, 2012;Herring and Texas Scottish Rite Hospital for Children, 2013). Strauss et al reported no complication under the age of 7 years old, possibly secondary to the intense remodeling in younger children (Strauss et al, 2012).…”

Posttraumatic Pseudoarthrosis of a Clavicle Fracture in an 11-Year-Old Girl: A Case Report and Analysis

“…The clavicle is the most commonly fractured bone in children, representing 6% to 15% of all paediatric fractures [1]. The vast majority of these fractures involve the middle third, and the majority are ubiquitously treated conservatively, using sling immobilization and serial radiological check-ups [2,3]. The reported incidence of nonunion in the paediatric population is extremely rare, in contrast to that known of the adult population, where the rate is from 8% to 14% [4].…”