TY - JOUR
T1 - Descriptive Epidemiology of Adolescent Clavicle Fractures
T2 - Results From the FACTS (Function after Adolescent Clavicle Trauma and Surgery) Prospective, Multicenter Cohort Study
AU - FACTS Study Group
AU - Ellis, Henry B.
AU - Li, Ying
AU - Bae, Donald S.
AU - Kalish, Leslie A.
AU - Wilson, Philip L.
AU - Pennock, Andrew T.
AU - Nepple, Jeffrey J.
AU - Willimon, Samuel C.
AU - Spence, David D.
AU - Pandya, Nirav K.
AU - Kocher, Mininder S.
AU - Edmonds, Eric W.
AU - Farley, Frances A.
AU - Gordon, J. Eric
AU - Kelly, Derek M.
AU - Busch, Michael T.
AU - Sabatini, Coleen S.
AU - Heyworth, Benton E.
N1 - Funding Information:
The authors acknowledge the support of the FACTS study research coordinators.
Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: This study received funding from the Boston Children’s Hospital Program for Patient Safety and Quality (research grant; 2013), Boston Children’s Hospital Trust (private donation; 2015), and Pediatric Orthopaedic Society of North America (POSNA Directed Research Grant; 2015-2018). M.S.K., E.W.E., and B.E.H. have received research funding from AlloSource and Vericel for the Research in OsteoChondritis of the Knee (ROCK) Study Group. H.B.E. has received educational support from Pylant Medical, speaking fees from Smith & Nephew and Synthes, and hospitality payments from Arthrex. P.L.W. has received educational support from Pylant Medical. A.T.P. has received educational support from Sportstek Medical, speaking fees from Smith & Nephew, and consulting fees from OrthoPediatrics. J.J.N. has received educational support from Arthrex and Elite Orthopaedics; speaking fees from Smith & Nephew; and consulting fees from Ceterix Orthopaedics, Responsive Arthroscopy, and Smith & Nephew. S.C.W. has received speaking fees from Arthrex and Smith & Nephew and consulting fees from Smith & Nephew. D.D.S. has received educational support from Gentleman Orthopedics Solutions. N.K.P. has received educational support from Evolution Surgical and consulting fees from OrthoPediatrics. M.S.K. has received consulting fees from OrthoPediatrics, Ossur, and Smith & Nephew; speaking fees from Smith & Nephew; honoraria from Stryker; and royalties from OrthoPediatrics. E.W.E. has received research support from DePuy, consulting fees from OrthoPediatrics, and speaking fees from Arthrex and Ossur. D.M.K. has received speaking fees from Medtronic and consulting fees from WishBone Medical. M.T.B. has received educational support from Arthrex and United Orthopedics, speaking fees from Arthrex, and consulting fees from OrthoPediatrics. B.E.H. has received educational support from Kairos Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Publisher Copyright:
© The Author(s) 2020.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Background: The majority of previous investigations on operative fixation of clavicle fractures have been related to the adult population, with occasional assessments of the younger, more commonly affected adolescent population. Despite limited prospective data for adolescents, the incidence of operative fixation of adolescent diaphyseal clavicle fractures has increased. Purpose: To detail the demographic features and descriptive epidemiology of a large pooled cohort of adolescent patients with diaphyseal clavicle fractures presenting to pediatric tertiary care centers in the United States through an observational, prospective, multicenter cohort study (Function after Adolescent Clavicle Trauma and Surgery [FACTS]). Study Design: Cross-sectional study; Level of evidence, 4. Methods: Patients aged 10 to 18 years who were treated for a diaphyseal clavicle fracture between August 2013 and February 2016 at 1 of 8 geographically diverse, high-volume, tertiary care pediatric centers were screened. Treatment was rendered by any of the pediatric orthopaedic providers at each of the 8 institutions, which totaled more than 50 different providers. Age, sex, race, ethnicity, fracture laterality, hand dominance, mechanism of injury, injury activity, athletic participation, fracture characteristics, and treatment decisions were prospectively recorded in those who were eligible and consented to enroll. Results: A total of 545 patients were included in the cohort. The mean age of the study population was 14.1 ± 2.1 years, and 79% were male. Fractures occurred on the nondominant side (56%) more frequently than the dominant side (44%). Sport was the predominant activity during which the injury occurred (66%), followed by horseplay (12%) and biking (6%). The primary mechanism of injury was a direct blow/hit to the shoulder (60%). Overall, 54% were completely displaced fractures, defined as fractures with no anatomic cortical contact between fragments. Mean shortening within the completely displaced group was 21.9 mm when measuring the distance between fragment ends (end to end) and 12.4 mm when measuring the distance between the fragment end to the corresponding cortical defect (cortex to corresponding cortex) on the other fragment (ie, true shortening). Comminution was present in 18% of all fractures. While 83% of all clavicle fractures were treated nonoperatively, 32% of completely displaced fractures underwent open reduction and internal fixation. Conclusion: Adolescent clavicle fractures occurred more commonly in male patients during sports, secondary to a direct blow to the shoulder, and on the nondominant side. Slightly more than half of these fractures were completely displaced, and approximately one-fifth were comminuted. Within this large cohort, approximately one-third of patients with completely displaced fractures underwent surgery, allowing for future prospective comparative analyses of radiographic, clinical, and functional outcomes.
AB - Background: The majority of previous investigations on operative fixation of clavicle fractures have been related to the adult population, with occasional assessments of the younger, more commonly affected adolescent population. Despite limited prospective data for adolescents, the incidence of operative fixation of adolescent diaphyseal clavicle fractures has increased. Purpose: To detail the demographic features and descriptive epidemiology of a large pooled cohort of adolescent patients with diaphyseal clavicle fractures presenting to pediatric tertiary care centers in the United States through an observational, prospective, multicenter cohort study (Function after Adolescent Clavicle Trauma and Surgery [FACTS]). Study Design: Cross-sectional study; Level of evidence, 4. Methods: Patients aged 10 to 18 years who were treated for a diaphyseal clavicle fracture between August 2013 and February 2016 at 1 of 8 geographically diverse, high-volume, tertiary care pediatric centers were screened. Treatment was rendered by any of the pediatric orthopaedic providers at each of the 8 institutions, which totaled more than 50 different providers. Age, sex, race, ethnicity, fracture laterality, hand dominance, mechanism of injury, injury activity, athletic participation, fracture characteristics, and treatment decisions were prospectively recorded in those who were eligible and consented to enroll. Results: A total of 545 patients were included in the cohort. The mean age of the study population was 14.1 ± 2.1 years, and 79% were male. Fractures occurred on the nondominant side (56%) more frequently than the dominant side (44%). Sport was the predominant activity during which the injury occurred (66%), followed by horseplay (12%) and biking (6%). The primary mechanism of injury was a direct blow/hit to the shoulder (60%). Overall, 54% were completely displaced fractures, defined as fractures with no anatomic cortical contact between fragments. Mean shortening within the completely displaced group was 21.9 mm when measuring the distance between fragment ends (end to end) and 12.4 mm when measuring the distance between the fragment end to the corresponding cortical defect (cortex to corresponding cortex) on the other fragment (ie, true shortening). Comminution was present in 18% of all fractures. While 83% of all clavicle fractures were treated nonoperatively, 32% of completely displaced fractures underwent open reduction and internal fixation. Conclusion: Adolescent clavicle fractures occurred more commonly in male patients during sports, secondary to a direct blow to the shoulder, and on the nondominant side. Slightly more than half of these fractures were completely displaced, and approximately one-fifth were comminuted. Within this large cohort, approximately one-third of patients with completely displaced fractures underwent surgery, allowing for future prospective comparative analyses of radiographic, clinical, and functional outcomes.
KW - adolescent
KW - clavicle fixation
KW - clavicle fracture
KW - pediatric
UR - http://www.scopus.com/inward/record.url?scp=85085611530&partnerID=8YFLogxK
U2 - 10.1177/2325967120921344
DO - 10.1177/2325967120921344
M3 - Article
C2 - 32528990
AN - SCOPUS:85085611530
SN - 2325-9671
VL - 8
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
IS - 5
ER -