Open reduction and internal fixation is a safe and effective option for older children with a clavicle fracture, researchers find.
Open Reduction for Clavicle Fractures? New Study Has Data.
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Most clavicle fractures in children are treated non-operatively, but recent research suggests that improved outcomes can be achieved with surgery, according to the study.
“Fractures of the clavicle are common in both adults and children. Recent studies in the treatment of adult fractures have indicated that improved outcomes are achieved after open reduction and internal fixation,” they wrote.
In the study, “Functional Outcomes of Clavicular Fractures Fixation in Adolescent Children,” published in the November 2020 issue of the International Journal of Orthopaedics, the researchers measured the functional outcomes after open reduction and internal fixation of displaced clavicle fractures in adolescent children.
They analyzed a retrospective case series of 28 adolescent children, looking particularly at the rate of healing, radiographic outcomes, functional outcomes and complications.
The average age of the children was 13.8 years and they were all boys. In 14 patients, the right side was injured, and in the other 14, the left. There were 26 mid-shaft fractures and two lateral-end fractures.
Patient outcomes were tracked for an average of 12 months. Overall, there were no superficial or deep infections and all patients experienced clinical and radiological union.
Twenty-four of the 28 children were able to return to unrestricted sport activity before the end of the follow-up period. The mean QuickDASH score at 12 months was 3.24.
Ten of the 28 patients did need to have metalwork removed. Four had plate prominence and four had scar sensitivity.
The researchers wrote, “Historically, almost all clavicle fractures in children were treated non-operatively regardless of the displacement and the location of fractures, with variable outcomes. We conclude that open reduction and internal fixation of displaced clavicle shaft fractures in older children can be performed safely and gives predictable results especially with healing period and functional outcomes.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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