Background: Fractures of the clavicle are common among adolescents and have traditionally been treated nonoperatively. Recent literature has demonstrated less satisfactory results than expected after conservative management of displaced fractures in adults. The purpose of this study was to evaluate the long-term patient-reported outcome after clavicle fractures in older children and adolescents.
Methods: Children aged 10 to 18 years who sustained a fracture of the clavicle between 2006 and 2008 were identified in our institution’s computerized files. The radiographs were examined and the fracture patterns, degree of dislocation, and shortening were measured. Medical records were reviewed and the patient-reported outcome was assessed using the Oxford Shoulder score and the Quick version of the Disability of Arm, Shoulder, and Hand questionnaire, and specific and general satisfaction scores.
Results: A total of 185 patients (median age, 14.4 y) with 172 midshaft and 13 lateral fractures were included in the study. Sixty-five (37.8%) of the midshaft fractures were displaced, and 9 of these were operated. There was one case of nonunion and one delayed union. One hundred twenty-two (70.9%) of the patients with a midshaft fracture responded to the questionnaires on an average 4.7 years after injury. Overall results were good to excellent for the majority of nonoperatively treated patients; however, shortening of the fracture had a negative effect on the Oxford Shoulder score (P=0.02), the cosmetic satisfaction score (P=0.02), and the overall satisfaction score (P=0.01).
Conclusions: The long-term patient-reported outcome after nonoperatively treated fractures of the clavicle in adolescents is good to excellent for the majority of the patients, and nonunion is rare. However, shortening of the fracture had a small negative effect on the outcome. Conservative management should remain the mainstay of management for fractures of the clavicle in this age group.
Level of Evidence: Level IV—retrospective case series.
*Health Services Research Unit (HØKH)
†Department of Orthopaedic Surgery, Akershus University Hospital
‡Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway
P-H.R. received the Akershus University Hospital internal research fund to finance production and distribution of the questionnaires. No funding has been received from the National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); or any pharmaceutical or industry related organization.
The authors declare no conflict of interest.
Reprints: Per-Henrik Randsborg, MD, PhD, Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog 1478, Norway. Email: firstname.lastname@example.org.