Surgical fixation of displaced clavicle fracture in adolescents: a review of literature

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

Introduction

Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents.

Materials and methods

This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 19972015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening.

Results

A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of non-union. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain.

Conclusion

Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Unplanned Operations and Adverse Events after Surgery for Diaphyseal Fracture of the Clavicle

BACKGROUND

We used a database of patients treated at three hospitals to study the primary null hypothesis that there are no factors associated with unplanned reoperations or adverse events after surgical repair for diaphyseal clavicle fracture. Additionally we addressed the following secondary study questions: 1. What is the prevalence of unplanned reoperations or adverse events after surgical repair for diaphyseal clavicle fracture? 2. Is early implant loosening or breakage after surgical repair for diaphyseal clavicle fracture related to fixation type? 3. Is the type of fixation associated with the prevalence of brachial plexus palsy after surgical repair of a diaphyseal clavicle fracture?

METHODS

We retrospectively analyzed 249 adult patients who had surgery for a diaphyseal clavicle fracture to determine factors associated with unplanned reoperations or adverse events. Thirty-two patients (13%) had at least one unplanned reoperation or adverse event. Four of 249 patients (1.6%) developed early implant loosening or breakage. Patients that had local implant irritation, planned implant removal, or sensory symptoms thought to be due to nerve irritation were not included in the reported unplanned reoperations or adverse event rate.

RESULTS

Only female sex was associated with unplanned reoperations or adverse events after surgery for diaphyseal clavicle fracture. No other patient, technical, or injury related factors tested in this study were associated with unplanned reoperations or adverse events.

CONCLUSION

Patients that have surgery for diaphyseal clavicle fracture have an approximately 13% risk of an unplanned second surgery or an adverse event. Women can be counseled that they are three times as likely as men to have an unplanned reoperations or adverse event.

Multiple pacemaker lead breakages due to clavicle dislocation following clavicle fracture

A 58-year-old man undergoing cardiac resynchronization therapy with a defibrillator in his right subcostal area fell from his bed, leading to fracture of the right clavicle. Serial radiographs showed dislocation of the distal clavicle 2 months after the initial fracture. Lead parameters dramatically changed after dislocation of the distal clavicle. Radiography indicated that the device leads seemed to be compressed by the distal clavicle in certain positions of the right upper limb. It was likely that various movements of the right upper limb during his daily life insidiously damaged the device leads, leading to the lead breakages.