Conservative versus surgical treatment of displaced midshaft clavicle fracture in adolescents.

Abstract

Midshaft clavicle fractures are common in childhood and their conservative treatment predominates. The indication for surgical treatment of adolescents with significantly displaced fractures remains controversial. The aim of this study was to compare the results of conservative or surgical treatment (intramedullary nailing) of these fractures. Retrospective clinical study of patients aged 1117 years with significantly displaced clavicle fractures treated at the Department of Pediatric Surgery and Traumatology, University Hospital Hradec Králové in 20112020. In this period, 696 patients with a clavicle fracture (excluding neonatal fractures) were treated. Of these, only 90 (13%) adolescent patients had significantly displaced diaphyseal fractures. Conservative approach was adopted in 52 (58%) of them; the remaining patients underwent a surgical procedure, while an intramedullary inserted and fixed titanium nail (TEN) was used in 20 (22%) cases. Supportive fixation was necessary in 4 of the operated patients. The duration of supportive fixation (basic therapeutic procedure for conservative treatment) was significantly shorter in operated patients (18 vs. 29 days, p=0.0001). No statistically significant difference was found in terms of the time interval of complete healing and return to full activity (74 vs. 85 days, p=0.051). There was one complication in the healing of the surgical wound; all patients healed without sequelae. According to the study, intramedullary osteosynthesis using a fixed titanium nail reduced the need for supportive fixation and allowed to shorten its time. Overall cosmetic and functional results were comparable to the conservative procedure. Therefore, this method can be recommended, especially for active adolescents.