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Nonoperative versus operative treatment for displaced midshaft clavicle fractures in adolescents

a comparative study

Song, Mi Hyuna; Yun, Yeo-Honb; Kang, Kimoonc; Hyun, Myung Jaec; Choi, Sungwookc

Journal of Pediatric Orthopaedics B: January 2019 - Volume 28 - Issue 1 - p 45–50
doi: 10.1097/BPB.0000000000000535
UPPER LIMB

We aimed to compare the outcomes and complications of nonoperative and operative treatment for displaced midshaft clavicle fractures in adolescents. Radiological and functional evaluations and complications for 23 patients with nonoperative treatment were compared with those for 18 patients with operative treatment. No nonunion developed in either group. No significant intergroup differences were observed for occurrence of delayed union or time to union (P=0.851 and 0.887, respectively). Both groups showed excellent functional outcomes on the basis of Disabilities of the Arm, Shoulder and Hand scores and Constant Shoulder Scores. Shoulder abduction strength and range of motion were also well restored in both treatment groups. However, recovery of shoulder range of motion was significantly faster in the operative group (mean: 5.3 weeks; range: 4.0–7.0 weeks) than in the nonoperative group (mean: 9.9 weeks; range: 8.0–19.0 weeks) (P<0.001). There were no patients in either treatment group who needed revisional surgery to address complications with functional deficits. Both nonoperative and operative treatments yielded excellent outcomes, without severe complications. On the basis of our results, nonoperative treatment is recommended as a primary treatment option for displaced midshaft clavicle fractures in adolescents. However, operative treatment can be considered in selected patients who require early functional recovery or have a high activity level.

aDepartment of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital

bDepartment of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul

cDepartment of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea

Correspondence to Sungwook Choi, MD, Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju-si, Jeju 63241, Republic of Korea Tel: +82 64 717 8116; fax: +82 64 717 2714; e-mail: swchoi1115@gmail.com

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