TY - JOUR
T1 - Nonoperative Versus Operative Treatment of Z-Type Comminuted Clavicle Fractures in Adolescents
T2 - A Prospective Substratified Cohort Analysis
AU - Sabatini, Coleen S.
AU - Edmonds, Eric W.
AU - Nepple, Jeffrey J.
AU - Liotta, Elizabeth S.
AU - Hergott, Katelyn
AU - Quinn, Michael
AU - Perkins, Crystal A.
AU - Wilson, Philip L.
AU - Li, Ying
AU - Ellis, Henry B.
AU - Pandya, Nirav K.
AU - Pennock, Andrew T.
AU - Spence, David D.
AU - Willimon, Samuel C.
AU - Bae, Donald S.
AU - Kocher, Mininder S.
AU - Busch, Michael T.
AU - Williams, David N.
AU - Heyworth, Benton E.
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - OBJECTIVES:To compare the clinical, radiographic, and patient-reported outcomes of nonoperative and operative treatment of adolescents with comminuted "Z-type" midshaft clavicle fractures.METHODS:Design:Prospective observational cohort.Setting:Eight tertiary care pediatric centers.Patient Selection Criteria:Patients aged 10-18 years who were treated either operatively or nonoperatively for a diaphyseal clavicle fracture between 2013 and 2017 were screened/enrolled at the time of injury. The current subcohort analysis was derived from a larger adolescent clavicle study population of 907 patients.Outcome Measurements and Comparisons:Complications and validated patient-reported outcome measures (PROs):(ASES, QuickDASH, Marx Shoulder Activity Score, EQ-5D, EQ-VAS, and patient satisfaction score) were compared between operative and nonoperative cohorts.RESULTS:Eighty-one patients (69 male [85.2%], 12 female; average age 15 years [11.1-18.7]; 78 with sports participation [96.2%]) were followed through bony healing and return to sports, while 59 patients (73%) completed 2-year follow-up with PROs, 26 of whom were treated nonoperatively and 33 treated operatively. All demographic and fracture characteristics were similar (P > 0.05) between the 2-year follow-up cohorts except for fracture shortening, which was greater in the operative cohort (23 vs. 29 mm, P = 0.01). After controlling for this potential confounder through both regression and propensity matched subgroup analysis, nonoperative versus operative cohorts showed no difference in rates of nonunion (0%), delayed union (0% vs. 2.3%, P = 1.0), symptomatic malunion (2.7% vs. 0%, P = 0.4), refracture (2.7% vs. 2.2%, P = 1.0), unexpected subsequent surgery (5.4% vs. 11.4%, P = 0.45), or clinically significant complications (5.4% vs. 16%, P = 0.17). There were no differences in any PROs between cohorts, both before and after controlling for the difference in fracture shortening (all P-values >0.05).CONCLUSIONS:In this prospective comparison of complications and 2-year PROs in adolescents with comminuted Z-type clavicle fractures, nonoperative and operative treatment yielded similar outcomes.LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
AB - OBJECTIVES:To compare the clinical, radiographic, and patient-reported outcomes of nonoperative and operative treatment of adolescents with comminuted "Z-type" midshaft clavicle fractures.METHODS:Design:Prospective observational cohort.Setting:Eight tertiary care pediatric centers.Patient Selection Criteria:Patients aged 10-18 years who were treated either operatively or nonoperatively for a diaphyseal clavicle fracture between 2013 and 2017 were screened/enrolled at the time of injury. The current subcohort analysis was derived from a larger adolescent clavicle study population of 907 patients.Outcome Measurements and Comparisons:Complications and validated patient-reported outcome measures (PROs):(ASES, QuickDASH, Marx Shoulder Activity Score, EQ-5D, EQ-VAS, and patient satisfaction score) were compared between operative and nonoperative cohorts.RESULTS:Eighty-one patients (69 male [85.2%], 12 female; average age 15 years [11.1-18.7]; 78 with sports participation [96.2%]) were followed through bony healing and return to sports, while 59 patients (73%) completed 2-year follow-up with PROs, 26 of whom were treated nonoperatively and 33 treated operatively. All demographic and fracture characteristics were similar (P > 0.05) between the 2-year follow-up cohorts except for fracture shortening, which was greater in the operative cohort (23 vs. 29 mm, P = 0.01). After controlling for this potential confounder through both regression and propensity matched subgroup analysis, nonoperative versus operative cohorts showed no difference in rates of nonunion (0%), delayed union (0% vs. 2.3%, P = 1.0), symptomatic malunion (2.7% vs. 0%, P = 0.4), refracture (2.7% vs. 2.2%, P = 1.0), unexpected subsequent surgery (5.4% vs. 11.4%, P = 0.45), or clinically significant complications (5.4% vs. 16%, P = 0.17). There were no differences in any PROs between cohorts, both before and after controlling for the difference in fracture shortening (all P-values >0.05).CONCLUSIONS:In this prospective comparison of complications and 2-year PROs in adolescents with comminuted Z-type clavicle fractures, nonoperative and operative treatment yielded similar outcomes.LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
KW - adolescent trauma
KW - comminuted clavicle fracture
KW - displaced clavicle fracture
KW - midshaft clavicle fracture
UR - http://www.scopus.com/inward/record.url?scp=85195336704&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000002821
DO - 10.1097/BOT.0000000000002821
M3 - Article
C2 - 38837911
AN - SCOPUS:85195336704
SN - 0890-5339
VL - 38
SP - 351
EP - 357
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 7
ER -