Operative Treatment of Completely Displaced Clavicle Shaft Fractures in Children

Author(s): Mehlman CT, Yihua G, Bochang CH and Zhigang W

Source: J Pediatr Orthop 29(8):851-855, 2009.

Summary:

Indications for surgery have been developed for displaced clavicle fractures in adults.  In certain fractures, level I evidence has established that closed treatment is inferior to operative treatment in terms of fracture healing and shoulder function.  This concept has not been firmly established in children.  The purpose this study was to retrospectively review the clinical x-ray results following operative treatment for completely displaced shaft fractures in children.

The retrospective review consisted over a 5 year span at Shanghai Children’s Medical Center.  Patients younger than 16 years of age with surgical treatment of displaced clavicle fractures were included.  A variety of information was collected from the chart review.  The cohort consisted of 21 male and 3 female patients.  The average age was approximately 12 years, with range from 7 to 16 years.  The follow-up was a little over 2 years time.  Operative fixation consisted of plate and screw fixation in 22 patients, isolated screw fixation in 1 patient and Kirschner wire fixation in 1 patient.  Eighty-seven percent of the children returned to unrestricted sport activity.  All fractures healed.  Complications included 2 patients with persistent scar sensitivity and 1 patient with a transient ulnar neurapraxia secondary to the initial injury. 

The discussion compares and contrasts this study to other pediatric cohorts of operative treatment following clavicle fractures.  However, the authors attempt to compare pediatric cohorts with those of the adult population.  The adult population has been studied very carefully regarding union, range of motion, and outcome.  There has been no similar assessment in children and this retrospective review does not attempt to quantify shoulder range of motion or outcome.  The authors conclude that operative fixation of clavicle shaft fractures appears to be reasonably safe and effective.  The authors site growth data that suggests that most of the clavicle length is present at a relative early age raising concerns about the remodeling potential in older children (see following article).

The conclusions from this study, however, must be interpreted with a “grain of salt.”  We can not project adult data into the pediatric population without similar scrutiny.  The risk and benefits must be carefully considered when contemplating operative fixation of pediatric clavicle fractures.  This article should not be used as springboard to initiate widespread operative treatment of displaced clavicle fractures in children.