Remodeling of Adolescent Displaced Clavicle Fractures: A Facts Study

Abstract

Background: The phenomenon of bony remodeling of healed displaced clavicle midshaft fractures in adolescents remains poorly understood. Hypothesis/Purpose: The purpose of the current study was to evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures treated non-operatively to understand the factors that may influence this process. Methods: Patients were identified from the database(s) of a multi-center study group investigating the functional outcomes of adolescent clavicle fractures. Patients between the ages of 10 and 19 years with completely displaced mid-diaphyseal clavicle fractures that were treated non-operatively who had further imaging of the affected clavicle at a minimum of 9 months from initial injury were included. Radiographic measurements were performed on the injury and final follow-up films. Fracture remodeling was subjectively classified as ‘complete/near-complete’, ‘moderate’, or ‘minimal’ (Figure 1) and subsequently analyzed quantitively and qualitatively to determine factors associated with deformity correction. Results: Eighty-one patients (mean age of 14.4±2.2 years) were analyzed at a mean radiographic follow-up of 34.8±24.3 months. Fracture shortening, superior displacement, and angulation significantly improved during the follow-up period by 60%, 57%, and 38% respectively. Fracture remodeling was found to be associated with patient age and follow-up time, with younger patients and those with longer follow-up undergoing more remodeling. All patients <14 years and 83% of patients ≥14 years-old at time of injury with a minimum follow-up of four years underwent complete/near-complete remodeling. Conclusion: Significant clavicle remodeling occurs in adolescent patients with displaced fractures, including older adolescents and particularly when followed for longer time intervals. This finding may help explain why symptomatic malunions are so infrequently observed in adolescent patients, even in severely displaced fractures. [Figure: see text]

An Evidence-Based Approach to Managing Adolescent (Ages 10 to 19 Years) Diaphyseal Clavicle Fractures

“…Representative cases demonstrating the remodeling capacity of nonsurgically management adolescent diaphyseal clavicle fracture. 10 In this review of 81 patients at a mean follow-up of 3 years, fracture shortening, superior displacement, and angulation markedly improved by 60%, 57%, and 38%, respectively. All patients were younger than 14 years and 83% of patients were 14 years and older at the time of injury with a minimum follow-up of 4 years for complete/near-complete remodeling.…”

“…9 Most recently, the FACTS (Function after Adolescent Clavicle Trauma and Surgery) study group demonstrated that 85% of patients were younger than 14 years and 54% of patients were 14 years or older at the time of injury, with a minimum follow-up of 4 years for complete/near-complete remodeling (Figure 5). 10 This contrasts with adult populations in which completely displaced diaphyseal clavicle fractures demonstrate little propensity for remodeling and carry high nonunion rates with nonsurgical management. 11…”

“…All patients were younger than 14 years and 83% of patients were 14 years and older at the time of injury with a minimum follow-up of 4 years for complete/near-complete remodeling. 10…”

5-Year Radiographic and Functional Outcomes of Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers

“…Bone remodeling was evaluated as either complete/near complete, moderate, or incomplete, as previously described (Figure 1). 24 Radiographic measurements were performed on the initial AP view of the affected clavicle, taken at the time of injury, and on the follow-up image. These measurements included end-to-end fracture shortening (in millimeters), superior fracture displacement (in millimeters), and fracture angulation (in degrees).…”

“…The American Journal of Sports Medicine 2024;52(4):1032-1039 DOI: 10.1177/03635465241228818 Ó 2024 The Author(s) from the initial investigation of McGraw et al 14 to more recent imaging studies 11,24 ; and (3) an increased body of research performed within the past decade assessing outcomes of various management strategies specific to adolescent clavicular fractures. 1,8,13,23,28,32 This prospective study aimed to assess longer-term outcomes of nonoperatively treated teenagers with completely displaced midshaft clavicular fractures.…”