Abstract
Objectives:
Optimal treatment for displaced clavicle fractures in adolescents remains controversial, with many surgeons favoring operative reduction and fixation. To prospectively assess patient reported outcomes (PROs) in teenagers undergoing non-operative treatment of a completely displaced clavicle fracture ≥ 5 years post-injury. Furthermore, bilateral clavicle imaging was used to determine the association between these outcomes and the presence or absence of bony remodeling.
Methods:
This study used a subset of patients previously enrolled in a multicenter study looking at adolescent clavicle fractures. Patients from a single institution and ≥ 13 years at the time of injury, with non-operatively treated completely displaced clavicle fractures who were ≥5 years out from their initial injury were able to participate in the study. Patients were clinically evaluated for evidence of scapular dyskinesia, strength deficits, and cosmetic concerns. Bilateral clavicle imaging was used to assess residual shortening, displacement, and angulation. PROs included: ASES, QuickDASH, Marx Shoulder Activity Scale, and return to sport data.
Results:
Twenty-four patients were available for follow-up, of whom 17 (71%) consented to the additional imaging. The mean age at the time of injury was 14.5±1.1 years with 89% being male. At a mean follow-up of 6.1 years, all fractures healed and no interventions were necessary (Figure 1). Significant remodeling was observed across all measurements with improvements of 70% in mean shortening (22.8 mm to 6.8 mm, p<0.001), 73% in superior displacement (13.4 mm to 3.6 mm, p<0.001), and 83% in angulation (10.4˚ to 1.8˚, p<0.001) (Figure 2). Thirteen patients (72%) had initial shortening > 2 cm and all remodeled to < 2 cm. PROs were almost universally excellent with no patients reporting shoulder pain and mean ASES, quickDASH, and Marx activity scores of99±3, 1±3, and 20±1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Majority (58%) were completely satisfied with the appearance of their shoulder, 38% were more satisfied than not, one patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 returned to sporting activities if interested. No PROs were associated with bony remodeling (p>0.05).
Conclusions:
Teenage patients with completely displaced clavicle fractures can expect excellent radiographic and clinical outcomes 5 years post-injury if treated non-operatively. This study further supports the role of non-operative treatment for teenagers, with nearly perfect outcomes reported bringing into question the role of acute operative management of these fractures given its associated risks and costs.
