Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment

Abstract

The purpose of the current review is to describe the management of displaced midshaft clavicle fractures in pediatric and adolescent patients. Midshaft clavicle fractures are relatively common in pediatric and adolescent patients. They most commonly occur from direct trauma and are often related to sports participation in adolescents. Recent literature in the management of adult midshaft clavicle fractures has supported operative management due to improved functional outcomes, decreased time to union, leading to early return to activity. A similar trend of increasing frequency in operative management has been seen in pediatric and adolescent patients with no consensus in the literature on optimal management. Nonoperative treatment consists of with a brief period of sling immobilization followed by range of motion. Operative management may be considered for open fractures, fractures with significant neurovascular compromise and soft tissue complications. Studies have shown comparable mid- to long-term functional and patient-reported outcomes after operative and nonoperative management of midshaft clavicle fractures in pediatric patients.

Splinting of Low-Risk Pediatric Fractures

“…12 In the setting of a fracture of the medial third of the clavicle, it requires more urgent evaluation by orthopedics with advanced imaging to evaluate for mediastinal injury that can commonly accompany these fractures. 13 Other factors such as displacement (>2 cm) and angulation may guide future decisions about nonoperative versus operative management but do not impact care in the acute setting. 12,13 For the acute care provider, these fractures can be placed in a sling with non-weight-bearing instructions for the affected extremity and outpatient orthopedic follow-up.…”

“…13 Other factors such as displacement (>2 cm) and angulation may guide future decisions about nonoperative versus operative management but do not impact care in the acute setting. 12,13 For the acute care provider, these fractures can be placed in a sling with non-weight-bearing instructions for the affected extremity and outpatient orthopedic follow-up. 13…”

“…12,13 For the acute care provider, these fractures can be placed in a sling with non-weight-bearing instructions for the affected extremity and outpatient orthopedic follow-up. 13…”

“…The middle third of the clavicle accounts for 90% of clavicle fractures, with the lateral and medial third each accounting for 5% 12 . In the setting of a fracture of the medial third of the clavicle, it requires more urgent evaluation by orthopedics with advanced imaging to evaluate for mediastinal injury that can commonly accompany these fractures 13 . Other factors such as displacement (>2 cm) and angulation may guide future decisions about nonoperative versus operative management but do not impact care in the acute setting 12,13 .…”