Operative treatment of adolescent clavicle fractures with an intramedullary clavicle pin

Abstract

Background: Adolescent clavicle fractures have traditionally been treated nonoperatively; however, recent literature in adults has shown improved outcomes with operative treatment of displaced and shortened clavicle fractures. It has been suggested that these results may translate to adolescents. This study presents an initial look at outcomes for operative treatment of displaced midshaft clavicle fractures in adolescents using an intramedullary clavicle pin.

Methods: Seventeen adolescent patients treated for a displaced, shortened midshaft clavicle fracture with an intramedullary clavicle pin between November 2007 and August 2009 were evaluated. Preoperative displacement, fracture union, and complications were reviewed, and shoulder scores were determined using the patient self-report section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form.

Results: Fracture union occurred in all 17 patients by 12 weeks. Average patient age was 15.8 years and ranged from 13 to 18 years. All but 2 implants were electively removed. The most common postoperative complaint was prominent hardware, which resolved after elective removal. There were no infections and only 1 patient reported decreased sensation at the incision site. Ten patients returned the American Shoulder and Elbow Surgeons form at an average time of 16.6 months after surgery. The average pain score was 44.2 of a possible 50 points. The average functional score was 44.3 of a possible 50 points. No patients reported severe difficulty with work activities and only 1 patient reported severe difficulty with sporting activities.

Conclusions: Operative treatment with an intramedullary clavicle pin seems to be a safe and effective treatment method for displaced midshaft clavicle fractures in adolescents.

Level of evidence: Therapeutic level IV.