Complications in the treatment of adolescent clavicle fractures

Abstract

This study evaluated the complications associated with the treatment of clavicle fractures in adolescents. All cases of clavicle fractures were identified during an 8-year period between January 2005 and January 2013. During the study period, 153 clavicle fractures occurred in patients between the ages of 14 and 17 years who were treated at the authors' center. Medical records and radiographs were reviewed to determine injury mechanism, fracture pattern, treatment, and complications. Injury severity was assessed as high, medium, and low. Patients with medial or distal metaphyseal fractures and intra-articular fractures were excluded. Of the 153 clavicle fractures, 23 (15.0%) were treated surgically. Compared with the fractures treated nonsurgically, the surgical fractures had greater shortening (mean, 2.0 vs 0.9 cm; P<.001) and were more likely to be comminuted (65.2% vs 23.1%; P<.001). Complications occurred in 21.7% of fractures treated surgically, including refracture (n=2), implant removal for prominence (n=2), and nonunion with implant failure (n=1). One complication was associated with intramedullary nailing, whereas the other 4 complications occurred in clavicles treated with plate fixation. In the non-surgical group, no patients sustained a refracture or malunion who required delayed surgical intervention. Pediatric fellowship-trained orthopedic surgeons treated 78 displaced fractures, resulting in 8 (10.3%) surgeries. Nonpediatric orthopedic specialists treated 46 displaced fractures, 15 (32.6%) of which were treated surgically (P=.0035).

Figure

A 15-year-old boy sustained a comminuted clavicle fracture from playing football. Preoperative radiograph showing significant clavicle shortening and a vertical fragment.

Figure 1

A 15-year-old boy sustained a comminuted clavicle fracture from playing football. Pre-operative radiograph showing significant clavicle shortening and a vertical fragment (A). Postoperative radiograph showing fixation with a pelvic reconstruction plate (B).

Figure 2

A 16-year-old female sustained after an all-terrain vehicle accident. Preoperative radiograph showing a displaced midclavicular fracture with 1.6 cm of shortening (A). Radiograph showing intramedullary nail fixation postoperatively (B). Radiograph 7 months after initial surgery showing nonunion with failed implant (C). Radiograph showing healed clavicle 1 year after revision plating (D).