O2104: Complications Surrounding Treatment of Distal Clavicle Fractures in the Pediatric and Adolescent Populations

Background: Midshaft clavicle fractures are commonly seen in the pediatric population; however, distal clavicle fractures are much less common. Distal clavicle fractures historically have been shown to have higher complication rates than midshaft fractures including an increased rate of nonunions. The purpose of this study was to assess the complications associated with a series of distal clavicle fractures.

Methods: A retrospective review was conducted to identify all pediatric and adolescent patients with clavicle fractures treated at our institution between 2011 and 2018. Patient demographics, mechanisms of injury, fracture pattern, immobilization type, immobilization length, treatment (operative or conservative),length of followup, and complications were recorded. Simple statistics were performed.

Results: Out of 205 pediatric and adolescent patients treated for a clavicle fracture, 14 patients (1.95%) with an average age of 11.77 years (Range: 2.37-15.87; SD: 3.76) were identified as having distal clavicle fractures. Of the 14 patients, 92.85% (n=13) were male. The cohort was immobilized for an average of 5.15 weeks (Range: 3-9.42 weeks; SD: 1.77) with 61.54% immobilized in a sling (n=8) and 38.46% treated with a shoulder immobilizer (n=5). Three of the patients (21.43%) were treated operatively with an open reduction and internal fixation procedure while the remainder were treated in a conservative, non-operative manner (n=11, 78.57%). The average length of follow-up for the operatively treated patients was 13.86 weeks (Range: 12.43- 14.86 weeks; SD: 1.27) with the non-operative follow-up having an average of 6.05 weeks (Range: 1.29-9.71 weeks; SD: 2.40). Of the operative cohort, there was only one complication noted where a screw backed out at one-month post-operatively following an ORIF necessitating removal. There were no complications noted in the conservatively treated cohort. No nonunions occurred in the entire cohort.

Conclusion: Pediatric fractures of the distal clavicle can be successfully treated with a low complication profile expected. The nonunion rate surrounding distal clavicle fractures may be overestimated if appropriate intervention is applied. Future studies assessing complications surrounding distal clavicle fractures in the pediatric and adolescent populations are warranted.