Effectiveness of surgical and conservative treatment of middle third clavicle fractures in Peruvian adolescents
DOI:
https://doi.org/10.58814/01208845.589Keywords:
Closed Fractures, Clavicle, Adolescent, Conservative Treatment, Surgical Intervention, Comparative StudyAbstract
Introduction: Clavicle fractures are quite frequent (2.6-10% of all fractures), occur predominantly in men (mainly during sports), and the diaphysis or midshaft is the most commonly fractured segment (69-90%); moreover, they are the most common type of fracture in adolescents. Although conservative management is used in most cases, given its effectiveness, surgery has increased in this age group, despite a higher risk of complications.
Objective: To determine the effectiveness of conservative and surgical management in Peruvian adolescents with displaced midshaft clavicle fracture.
Methodology: Single-center retrospective cohort study conducted in 36 adolescents with midshaft clavicle fracture treated in a trauma service in Trujillo (Peru) between 2018 and 2022: 18 patients underwent surgery and 18 received conservative management. Effectiveness was measured in terms of functional outcomes using the QuickDASH scale. Satisfaction with cosmetic outcomes was also assessed using a 5-point Likert scale. Both measurements were performed 3 months after the end of treatment. Differences between groups were assessed using Chi-square and Mann-Whitney U tests
Results: Functional outcomes were satisfactory in both groups, with no significant differences in the QuickDASH score (p=0.784). Complications were observed only in the surgery group, in which 4 patients (22.2 %) required a second surgery after fracture healing for implant removal due to protrusion and pain (p=0.034). Finally, the proportion of patients satisfied with the cosmetic outcomes of the treatment was significantly higher in those treated conservatively (77.8 % vs. 11.1%; p=0.001).
Conclusions: Both therapeutic approaches provide satisfactory functional outcomes. However, conservative management is significantly superior to surgery in terms of lower morbidity and higher satisfaction with cosmetic outcomes.
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Bentley TP, Hosseinzadeh S. Clavicle Fractures. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. PMID: 29939669.
Frima H, van Heijl M, Michelitsch C, van der Meijden O, Beeres FJP, Houwert RM, et al. Clavicle fractures in adults; current concepts. Eur J Trauma Emerg Surg. 2020;46(3):519-29. doi: 10.1007/s00068-019-01122-4. PMID: 30944950.
Saragaglia D, Refaie R. Displaced mid-shaft clavicular fractures: state of the art for athletes and young active people. Int Orthop. 2021;45(10):2679-2686. doi: 10.1007/s00264-021-05113-2. PMID: 34309695.
Feng D, Jiang W, Kang X, Jiang Y, Zhu Y, Zhang J. Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes. BMC Musculoskelet Disord. 2023;24(1):112. doi: 10.1186/s12891-023-06228-w. PMID: 36765310; PMCID: PMC9912484.
Arcos-Gutiérrez MI, Barros-Segovia JA, Cevallos-Mendoza CD, Ollague-Armijos RB. Tratamiento conservador en fractura de clavícula. RECIMUNDO. 2020. 3(4): 571-85. doi: 10.26820/recimundo/3.(4).diciembre.2019.571-585.
Sassi E, Hannonen J, Serlo W, Sinikumpu J. Increase in surgical fixation of pediatric midshaft clavicle fractures since 2008. BMC Musculoskelet Disord. 2022; 23(1):173. doi: 10.1186/s12891-021-04918-x. PMID: 35197020; PMCID: PMC8864931.
Cole MW, Collins LK, Familia MM, Skalak TJ, Lee OC, Sherman WF. Trends in the Treatment of Adolescent Clavicle Fractures: Are We Listening to the Evidence? J Am Acad Orthop Surg Glob Res Rev. 2023;7(2):e22.00277. doi: 10.5435/JAAOSGlobal-D-22-00277. PMID: 36745543; PMCID: PMC9901955.
Nawar K, Eliya Y, Burrow S, Peterson D, Ayeni O, de Sa D. Operative Versus Non-operative Management of Mid-diaphyseal Clavicle Fractures in the Skeletally Immature Population: A Systematic Review and Meta-analysis. Curr Rev Musculoskelet Med. 2020;13(1):38-49. doi: 10.1007/s12178-020-09604-4. PMID: 31970646; PMCID: PMC7083995.
Hosseinzadeh P, Pokala N, Meyer Z, Minaie A, Brea C, Gonzalez D, et al. Clavicles continue to grow beyond skeletal maturity: radiographic analysis of clavicle length in adolescents and young adults. J Pediatr Orthop B. 2020;29(2):195-9. doi: 10.1097/BPB.0000000000000644. PMID: 31356506.
Randsborg PH, Fuglesang HF, Røtterud JH, Hammer OL, Sivertsen EA. Long-term patient-reported outcome after fractures of the clavicle in patients aged 10 to 18 years. J Pediatr Orthop. 2014; 34(4):393-9. doi: 10.1097/BPO.0000000000000082. PMID: 23965911.
Markes AR, Garcia-Lopez E, Halvorson RT, Swarup I. Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment. Orthop Res Rev. 2022;14:373-381. doi: 10.2147/ORR.S340538. PMID: 36345395; PMCID: PMC9636878.
Suppan CA, Bae DS, Donohue KS, Miller PE, Kocher MS, Heyworth BE. Trends in the volume of operative treatment of midshaft clavicle fractures in children and adolescents: a retrospective, 12-year, single-institution analysis. J Pediatr Orthop B. 2016;25(4):305-9. doi: 10.1097/BPB.0000000000000301. PMID: 26990058.
Pennock AT, Bastrom TP, Boutelle KE, Carroll AN, Edmonds EW, Nepple JJ, et al. Bony Remodeling of Adolescent Displaced Clavicle Fractures: A FACTS Study. Am J Sports Med. 2023;51(4):871-6. doi: 10.1177/03635465231152884. Erratum in: Am J Sports Med. 2023;51(6):NP19. doi: 10.1177/03635465231168388. PMID: 36802767.
Ahearn BM, Shanley E, Thigpen CA, Pill SG, Kissenberth MJ. Factors influencing time to return to sport following clavicular fractures in adolescent athletes. J Shoulder Elbow Surg. 2021;30(7S):140-4. doi: 10.1016/j.jse.2021.04.006. PMID: 33895299.
Pandya NK. Adolescent Clavicle Fractures: Is There a Role for Open Reduction and Internal Fixation. Curr Rev Musculoskelet Med. 2019;12(2):228-32. doi: 10.1007/s12178-019-09553-7. PMID: 30924049; PMCID: PMC6542967.
Li Y, Helvie P, Farley FA, Abbott MD, Caird MS. Complications After Plate Fixation of Displaced Pediatric Midshaft Clavicle Fractures. J Pediatr Orthop. 2018;38(7):350-3. doi: 10.1097/BPO.0000000000000832. PMID: 27379787.
García-González LA, Aguilar-Sierra F, Rodríguez-Ricard MC. Validación de la versión en español de la escala de función del miembro superior abreviado: Quick Dash. Rev Col Or Tra. 2018;32(4):215-9. doi: 10.1016/j.rccot.2017.06.012.
Patel M, Heyworth BE, Dehghan N, Mehlman CT, McKee MD. Clavicular Fractures in the Adolescent. J Bone Joint Surg Am. 2023;105(9):713-23. doi: 10.2106/JBJS.22.01036. PMID: 36753567.
Štichhauer R, Lešková J, Šafus A, Preis J. Conservative versus surgical treatment of displaced midshaft clavicle fracture in adolescents. Rozhl Chir. 2022;101(2):66-71. English. doi: 10.33699/PIS.2022.101.2.66-71. PMID: 35240843.
Kamaci S, Bess L, Glogovac G, Colosimo AJ. Plate osteosynthesis of midshaft clavicle fractures in adolescent contact sports athletes - adolescent clavicle fracture. J Pediatr Orthop B. 2022; 31(1):1-6. doi: 10.1097/BPB.0000000000000810. PMID: 32991374.
Kim HY, Yang DS, Bae JH, Cha YH, Lee KW, Choy WS. Clinical and Radiological Outcomes after Various Treatments of Midshaft Clavicle Fractures in Adolescents. Clin Orthop Surg. 2020;12(3):396-403. doi: 10.4055/cios20026. PMID: 32904052; PMCID: PMC7449852.
Swarup I, Maheshwer B, Orr S, Kehoe C, Zhang Y, Dodwell E. Intermediate-Term Outcomes Following Operative and Nonoperative Management of Midshaft Clavicle Fractures in Children and Adolescents. Internal Fixation May Improve Outcomes. JB JS Open Access. 202119;6(1):e20.00036. doi: 10.2106/JBJS.OA.20.00036. PMID: 33748645; PMCID: PMC7963509.
Rossi LA, Magno G, Tanoira I, Puigdevall MH, Bosio S, Ranalletta M. Surgical fixation of displaced midshaft clavicular fractures with precontoured plates in adolescents. Rev Esp Cir Ortop Traumatol (Engl Ed). 2021;65(3):223-228. English, Spanish. doi: 10.1016/j.recot.2020.08.002. PMID: 33419672.
Riiser MO, Molund M. Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study. J Pediatr Orthop. 2021;41(5):279-83. doi: 10.1097/BPO.0000000000001768. PMID: 33606445.
Scott ML, Baldwin KD, Mistovich RJ. Operative Versus Nonoperative Treatment of Pediatric and Adolescent Clavicular Fractures: A Systematic Review and Critical Analysis. JBJS Rev. 2019;7(3):e5. doi: 10.2106/JBJS.RVW.18.00043. PMID: 30889007.
Ariga A, Shimura H, Fujita K, Nimura A. Anteroinferior plating is an independent factor for decreasing symptomatic implant removal rates after plate fixation for midshaft clavicle fractures. OTA Int. 2023;8;6(1):e253. doi: 10.1097/OI9.0000000000000253. PMID: 36846523; PMCID: PMC9953037.
Chirinos Sipirán RM, Vargas Morales RE. Recuperación funcional en pacientes con fractura de clavícula según técnicas de tratamiento. Revista Cubana de Ortopedia y Traumatología [Internet]. 2021 [cited 2025 June 27];35(3). Available from: https://revortopedia.sld.cu/index.php/revortopedia/article/view/342.
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4. doi: 10.1001/jama.2013.281053. PMID: 24141714.
Colombia. Congreso de la República. Ley General de Salud Ley Nº 26842 [Internet]. Lima; July 9 1997 [cited 2025 May 27]. Available from: : https://www.minsa.gob.pe/Recursos/OGTI/SINADEF/Ley-26842.pdf.
Colegio Médico del Perú. Código de Ética y Deontología [Internet]. Lima: Colegio Médico del Perú; 2023 [cited 2025 May 27]. Available from: https://www.cmp.org.pe/wp-content/uploads/2024/09/Codigo-de-Etica-2023-nueva-version.pdf.
Mitchell BC, Ellis H, Wilson P, Pennock AT. An Evidence-Based Approach to Managing Adolescent (Ages 10 to 19 Years) Diaphyseal Clavicle Fractures. J Am Acad Orthop Surg. 2024;32(4):e156-e165. doi: 10.5435/JAAOS-D-23-00116. PMID: 37903450.
Jasty NM, The FACTS Study Group; Heyworth BE. Evaluation and Management of Midshaft Clavicle Fractures in Adolescents. JPOSNA. 2020;2(3):172. DOI: 10.55275/JPOSNA-2020-172.
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