Trends in the volume of operative treatment of midshaft clavicle fractures in children and adolescents: a retrospective, 12-year, single-institution analysis

Suppan, Catherine; Bae, Donald S.; Donohue, Kyna S; Miller, Patricia E.; Kocher, Mininder S.; Heyworth, Benton E.

doi:10.1097/bpb.0000000000000301

Cited by 39 publications

(36 citation statements)

References 30 publications

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“…The trend towards surgery in the skeletally immature population has taken place despite the absence of level 1 evidence demonstrating its effectiveness [7,36,37]. Two studies (both with an N = 16) looking at conservative treatment of skeletally immature mid-diaphyseal clavicle fractures with 100% displacement and > 2 cm of shortening had a 100% union rate; however all fractures developed malunion [38,39].…”

Section: Discussionmentioning

confidence: 99%

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

Nawar

Eliya

Burrow

et al. 2020

Curr Rev Musculoskelet Med

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Purpose The purpose of this study is to compare the outcomes and complications of operative vs non-operative management of mid-diaphyseal clavicle fractures in the skeletally immature population. Recent Findings Traditionally, skeletally immature clavicle fractures have been managed non-operatively. However, there has been an increasing trend towards operative management with a lack of evidence indicating its effectiveness. Methods Two reviewers searched three online databases (MEDLINE, EMBASE and PubMed), independently and in duplicates, for literature comparing the outcomes and complications of operative versus non-operative management in skeletally-immature patients (defined as birth to 18 years of age) with a middiaphyseal clavicle fracture. Where possible, risk ratios (RR) and mean differences (MD) were combined using a random effects model. Results Seven studies, containing 522 skeletally immature patients (with 528 mid-diaphyseal clavicle fractures) with an age range of 8 to 18 years, with 148 patients undergoing operative management and 380 patients undergoing non-operative management, were included. Across the 6 studies that reported gender (N = 444), there were 335 males and 109 females. Patients were followed up from 2 weeks to 3.7 years across five studies (N = 201 patients) that reported follow-up time. There was no significant difference in the time to achieve union (p = 0.1), the time to return to activity (p = 0.09), and the overall complication rate (p = 0.50) between the operative and the non-operative groups. Summary There is no significant difference between operative and non-operative management of skeletally immature middiaphyseal clavicle fractures. Clinical equipoise exists to study this further by means of a prospective, randomized, blinded control trial. Level of Evidence Level IV, systematic review and meta-analysis of level II, III, and IV.

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Section: Discussionmentioning

confidence: 99%

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

Nawar

Eliya

Burrow

et al. 2020

Curr Rev Musculoskelet Med

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“…As described throughout the literature, surgical treatment of clavicle fractures in adolescents is heavily influenced by fracture pattern and severity. 3,7,10,18,27 In a survey of Pediatric Orthopaedic Society of North America members in 2011, more than 90% of members were in favor of nonoperative treatment for nondisplaced and angulated-type midshaft clavicle fractures, while segmental fracture treatment was more variable, with almost half the respondents favoring operative management. 3 A recent meta-analysis of randomized controlled trials found that, when compared with nonoperative treatment, plate fixation significantly reduces the risk of nonunion in the setting of displaced midshaft clavicular fractures.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017

McCarthy

Bihl

Frank

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Little is known about the epidemiology of clavicle fractures in United States (US) high school athletes. Sports participation among high school students has increased steadily, placing increased numbers at risk of sports-related injury. Purpose: To describe the epidemiology of clavicle fractures among high school athletes, including injury rates by sex, sport, and type of play and trends in operative versus nonoperative treatment. Study Design: Descriptive epidemiology study. Methods: The study data set included all athlete-exposure (AE) and clavicle fracture data collected from 2008-2009 through 2016-2017 from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study for students participating in boys’ football, boys’/girls’ soccer, boys’/girls’ basketball, boys’/girls’ volleyball, boys’ wrestling, boys’ baseball, girls’ softball, girls’ field hockey, boys’ ice hockey, boys’/girls’ lacrosse, boys’/girls’ swimming and diving, boys’/girls’ track and field, girls’ gymnastics, girls’ cheerleading, boys’/girls’ tennis, and boys’/girls’ cross-country. Results: Overall, 567 clavicle fractures were reported during 31,520,765 AEs, an injury rate of 1.80 per 100,000 AEs. Injury rates varied by sport, with the highest rates in the boys’ full-contact sports of ice hockey (5.27), lacrosse (5.26), football (4.98), and wrestling (2.21). Among girls’ sports, the highest rates were in soccer (0.92), lacrosse (0.26), and basketball (0.25). In sex-comparable sports, injury rates were still significantly higher among boys (1.03) than girls (0.35) (rate ratio, 2.91; 95% CI, 1.97-4.30). Injury rates were significantly higher in competition (4.58) as compared with practice (0.87) (rate ratio, 5.27; 95% CI, 4.44-6.26). Most injuries were treated conservatively (82.7%) rather than operatively (17.3%). Time to return to sports varied, with a greater proportion of medical disqualifications among those treated operatively (40.0%) as compared with those treated conservatively (22.6%) (injury proportion ratio, 1.77; 95% CI, 1.31-2.39). Conclusion: Although clavicle fracture rates are relatively low, they vary by sport, sex, and activity. Understanding such differences should drive more effective, targeted injury prevention efforts. Increased time loss from sports with surgical versus conservative treatment may have been influenced by factors including injury severity and its timing relative to the season’s progress.

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“…In this group of the population, nonoperative management results in good functional outcomes [18,19,20]. However, many surgeons are still performing surgery to treat clavicle fractures in skeletally immature patients as the surgery has the advantage of earlier return to school, better pain response, and less risk of malunion and nonunion, however, the level 1 evidence is still lacking [7,10,21].…”

Section: Vas = Visual Analogue Scalementioning

confidence: 99%

“…Traditionally, operative treatment has been achieved by plate and screws [7,10,11]. Recently, intramedullary fixation is gaining increased interest in the literature [12,13].…”

Section: Introductionmentioning

confidence: 99%

Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

Rai²,

et al. 2020

Preprint

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Background: Traditionally, operative treatment for displaced midshaft clavicle fractures in adolescents has been achieved by a plate and screws. However, a minimally invasive trend in most of the surgeries has led the pediatric orthopedic surgeons to use elastic stable intramedullary nail (ESIN) for displaced midshaft clavicle fractures. This study aims to compare the clinical outcomes of adolescent patients who were surgically treated with the (ESIN) and plate for displaced midshaft clavicle fractures.Methods: A total of 73 patients, aged between 10 years and 14 years, with displaced midshaft clavicle fractures were treated surgically from January 2014 to January 2018. Patients were categorized into two groups, ESIN (n = 45; male 27, female 18) and plate (n = 28; male17, female 11) according to surgical technique. The preoperative data, including baseline information of the patients, radiographic parameters, and types of surgical procedure, were collected from the hospital database. The postoperative data, including clinical outcome and complications, were collected during the follow-up visit. Clinical outcome was evaluated using the American Shoulder and Elbow Surgeons (ASES).Results: The average age of the patients in the ESIN group was 12.2±1.5 years, and that in the Plate group was 12.2±1.4 years. There was a significantly less operative time, reduced estimated blood loss (EBL), shortened hospital stay and smaller incision for ESIN group as compared to the Plate group (P<0.01). The rate of scar concern was much higher in plate (14/28, 50%) than ESIN (2/45, 4.4%) , (P <0.01). There was no statistically significant difference in shoulder function between the ESIN group (94.5±2.8) and the Plate group (95.1±2.7), P = 0.36. In all the cases, implant removal was performed between 4 and 12 months postoperatively, and the ESIN group had significantly less operative time, EBL and shortened hospital stay as compared to the plate for implant removal (P<0.01).Conclusion: Both the ESIN and Plate are safe and effective treatment methods for displaced midshaft clavicle fractures in adolescents. The ESIN is superior to plate in terms of shorter operative time, less intraoperative radiation exposure, shorter hospital stay, less scar concern and easier implant removals. However, ESIN for heavier kids remain cautious.

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Trends in the volume of operative treatment of midshaft clavicle fractures in children and adolescents: a retrospective, 12-year, single-institution analysis

Cited by 39 publications

References 30 publications

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis

Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017

Optimal operative choice for displaced midshaft clavicle fractures in adolescents: a comparative study of intramedullary flexible nails and plating

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