TY - JOUR
T1 - 5-Year Radiographic and Functional Outcomes of Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers
AU - Polinsky, Samuel G.
AU - Edmonds, Eric W.
AU - Bastrom, Tracey P.
AU - Manhard, Claire E.
AU - Heyworth, Benton E.
AU - Bae, Donald S.
AU - Busch, Michael T.
AU - Ellis, Henry B.
AU - Hergott, Katelyn
AU - Kocher, Mininder S.
AU - Li, Ying
AU - Nepple, Jeffrey J.
AU - Pandya, Nirav K.
AU - Perkins, Crystal
AU - Sabatini, Coleen S.
AU - Spence, David D.
AU - Willimon, Samuel C.
AU - Wilson, Philip L.
AU - Pennock, Andrew T.
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/3
Y1 - 2024/3
N2 - Background: Optimal treatment of completely displaced midshaft clavicular fractures in adolescents remains controversial, with some favoring surgical management and others favoring a nonoperative approach. Few studies have comprehensively assessed longer-term nonoperative outcomes. Purpose: To prospectively assess patient-reported outcomes (PROs) and radiographic remodeling ≥5 years after injury in teenagers undergoing nonoperative treatment of completely displaced clavicular fractures. Study Design: Case series; Level of evidence, 4. Methods: Adolescent patients previously enrolled in a prospective study from a single institution with nonoperatively treated, completely displaced midshaft clavicular fractures ≥5 years from injury were eligible for the study. Patients were clinically evaluated for scapular dyskinesia and strength deficits. Bilateral clavicular imaging assessed residual shortening, displacement, and angulation. PROs included the American Shoulder and Elbow Surgeons (ASES), the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Marx Shoulder Activity Scale, cosmesis, and return to sports data. Results: A total of 24 patients were available for the follow-up, of whom 17 (71%) consented to additional imaging. The mean cohort age at the time of injury was 14.5 ± 1.1 years, with 88% being male. At a mean follow-up of 6.1 years, all fractures had healed, with no patient requiring secondary interventions. Significant remodeling was observed across all measurements, with improvements of 70% in shortening (22.8 to 6.8 mm; P <.001), 73% in superior displacement (13.4 to 3.6 mm; P <.001), and 83% in angulation (10.4° to 1.8°; P <.001). Thirteen patients (72%) had a >2-cm initial shortening, and all remodeled to <2 cm. PROs were almost universally excellent, with mean ASES, QuickDASH, and Marx activity scores of 99 ± 3, 1 ± 3, and 20 ± 1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Most patients (58%) were completely satisfied with their shoulder appearance, 38% were more satisfied than not, 1 patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 who were interested in sports returned to sporting activities. PROs were not associated with bony remodeling (P >.05). Conclusion: Teenaged patients with completely displaced clavicular fractures treated nonoperatively can expect excellent radiographic and clinical outcomes 5 years after injury.
AB - Background: Optimal treatment of completely displaced midshaft clavicular fractures in adolescents remains controversial, with some favoring surgical management and others favoring a nonoperative approach. Few studies have comprehensively assessed longer-term nonoperative outcomes. Purpose: To prospectively assess patient-reported outcomes (PROs) and radiographic remodeling ≥5 years after injury in teenagers undergoing nonoperative treatment of completely displaced clavicular fractures. Study Design: Case series; Level of evidence, 4. Methods: Adolescent patients previously enrolled in a prospective study from a single institution with nonoperatively treated, completely displaced midshaft clavicular fractures ≥5 years from injury were eligible for the study. Patients were clinically evaluated for scapular dyskinesia and strength deficits. Bilateral clavicular imaging assessed residual shortening, displacement, and angulation. PROs included the American Shoulder and Elbow Surgeons (ASES), the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Marx Shoulder Activity Scale, cosmesis, and return to sports data. Results: A total of 24 patients were available for the follow-up, of whom 17 (71%) consented to additional imaging. The mean cohort age at the time of injury was 14.5 ± 1.1 years, with 88% being male. At a mean follow-up of 6.1 years, all fractures had healed, with no patient requiring secondary interventions. Significant remodeling was observed across all measurements, with improvements of 70% in shortening (22.8 to 6.8 mm; P <.001), 73% in superior displacement (13.4 to 3.6 mm; P <.001), and 83% in angulation (10.4° to 1.8°; P <.001). Thirteen patients (72%) had a >2-cm initial shortening, and all remodeled to <2 cm. PROs were almost universally excellent, with mean ASES, QuickDASH, and Marx activity scores of 99 ± 3, 1 ± 3, and 20 ± 1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Most patients (58%) were completely satisfied with their shoulder appearance, 38% were more satisfied than not, 1 patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 who were interested in sports returned to sporting activities. PROs were not associated with bony remodeling (P >.05). Conclusion: Teenaged patients with completely displaced clavicular fractures treated nonoperatively can expect excellent radiographic and clinical outcomes 5 years after injury.
KW - adolescent
KW - clavicular fracture
KW - functional outcome
KW - trauma
UR - http://www.scopus.com/inward/record.url?scp=85186865083&partnerID=8YFLogxK
U2 - 10.1177/03635465241228818
DO - 10.1177/03635465241228818
M3 - Article
C2 - 38439558
AN - SCOPUS:85186865083
SN - 0363-5465
VL - 52
SP - 1032
EP - 1039
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 4
ER -