Rates of Operative Management of Midshaft Clavicle Fracture in Adolescents

Abstract

Purpose: Treatment of midshaft clavicle fractures in adolescents remains controversial. The adult literature suggests more favorable outcomes with open reduction internal fixation (ORIF), and it is unknown how this has influenced the management in the adolescent population over the past decade. The purpose of this study was to longitudinally evaluate the rates of operative management of midshaft clavicle fractures in adolescent patients. Methods: The Healthcare Cost and Utilization Project State Inpatient Database, State Ambulatory Surgery and Services Database, and State Emergency Department Database were evaluated for the years 2005–2015. Patients 10–18 years-old with a midshaft clavicle fracture, who underwent operative or nonoperative management, were identified using diagnosis and procedure codes. Data regarding age, sex, race, insurance type, and income percentile were also collected. The overall number of fractures managed operatively and nonoperatively were compared. Throughout the study period, factors associated with operative and non-operative management were analyzed. Descriptive statistics as well as univariate and multivariate analyses were performed. Results: There were 4,815 adolescent midshaft clavicle fractures identified between 2005 and 2015, and 375 (7.8%) of these fractures underwent operative management. There was a significant increase in the rate of operative management from 4.26% (n = 62) between 2005 and 2008 to 12.13% (n=141) between 2012 and 2015 (p<0.001). This increase was seen across all racial groups (p<0.05). Patients undergoing operative management were significantly older [16.0±1.7 vs. 14.1±2.3 years-old, p<0.001], were more likely to have Medicaid insurance (p<0.001), and were more likely to be in the bottom 75th percentile for income. Conclusion: The rate of adolescent midshaft clavicle fractures treated operatively has significantly increased over the past decade, and there are several demographic and socioeconomic differences between patients treated with and without surgery. Additional outcomes research is needed to justify this trend in adolescent patients with midshaft clavicle fractures in the bottom 75th percentile income brackets. Additional studies are needed to understand and validate the increased rates in operative management of midshaft clavicle fractures in adolescents.