There is an increasing trend toward stabilization and fixation of markedly displaced midshaft clavicle fractures in adolescents. Recent studies in the adult literature have shown a greater prevalence of symptomatic malunion, nonunion, and poor functional outcomes after nonsurgical management of displaced fractures. Fixation of displaced midshaft clavicle fractures can restore length and alignment, resulting in shorter time to union. Symptomatic malunion after significantly displaced fractures in adolescents may be more common than previously thought. Adolescents often have high functional demands, and their remodeling potential is limited. Knowledge of bone biology and the effects of shortening, angulation, and rotation on shoulder girdle mechanics is critical in decision making in order to increase the likelihood of optimal results at skeletal maturity. Selection of fixation is dependent on many factors, including fracture type, patient age, skeletal maturity, and surgeon comfort.
From the Department of Pediatric Orthopaedic Surgery, Rady Children's Hospital‐San Diego, San Diego, CA (Dr. Pandya and Dr. Hosalkar) and the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Namdari).
Dr. Pandya or an immediate family member serves as a board member, owner, officer, or committee member of the Pediatric Orthopaedic Society of North America. Dr. Hosalkar or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Synthes, serves as a paid consultant to or is an employee of Allergan and Synthes, and has stock or stock options held in GlaxoSmithKline, Johnson & Johnson, and Pfizer. Neither Dr. Namdari nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.