Comparative Effectiveness of Nonoperative Versus Operative Treatment of Completely Displaced Clavicle Shaft Fractures Among Children

Abstract

The goal of this study was to compare outcomes among children treated nonoperatively vs operatively for completely displaced clavicle fractures. This was a retrospective cohort study of nonoperative vs operative treatment of completely displaced clavicle fractures sustained between 2006 and 2015 among pediatric patients. Data were collected on patient demographics, fracture characteristics, time to return to full activities, treatment complications, and patient-reported outcome measures. Fifty-five patients were identified in the nonoperative group, with a mean age of 11.6 years (range, 8–14 years). The operative group contained 55 patients, with a mean age of 14.3 years (range, 9–17 years). All fractures healed, with a mean time to return to full activities of 90.4 days in the nonoperative group and 89.7 days in the operative group ( P =.941). Twelve (22%) nonoperative patients sustained a refracture of their clavicle compared with 4 patients in the operative group ( P =.031). Fifteen patients (27%) in the operative group required a second surgery for removal of surgical implants. On the shortened form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey, 17 of the 22 nonoperative patients reported a score of zero (indicating no disability) (range, 0–7) vs 22 of 25 in the operative group (range, 0–9) ( P =.329). Patients treated nonoperatively had a 22% rate of refracture, whereas patients treated operatively had a 27% rate of undergoing a second surgery for removal of surgical implants. These data can aid in the shared decision-making process with patients and families when deciding on treatment for displaced pediatric clavicle fractures. [ Orthopedics . 2022;45(6):373–377.]