Nonoperative treatment of displaced clavicle fractures yielded higher refracture rate
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While operative and nonoperative treatment of displaced clavicle fractures had similar time to return to activity, results showed nonoperative treatment had higher refracture rates and operative treatment had higher secondary surgery rates.
“Pediatric clavicle fractures are a common problem, and the decision on how to treat them is not always straightforward,” Tyler D. Ames, MD, an orthopedic surgery fellow in adult reconstruction at The Ohio State University Wexner Medical Center, told Healio. “There are many factors to take into consideration, and the risks and benefits of both nonoperative and operative treatment should be discussed with the patient and family. Our paper offers new points to discuss with families in the risk column of nonoperative treatment.”
Ames and colleagues compared patient demographics, fracture characteristics, time to return to full activities, treatment complications and patient-reported outcome measures among pediatric patients with completely displaced clavicle fractures who underwent either open reduction and internal fixation (n=55) or nonoperative (n=55) treatment between 2006 and 2015.
Results showed all fractures in both groups healed, with a mean time to return to full activities of 90.4 days and 89.7 days in the nonoperative group and operative group, respectively.
Ames noted “patients treated nonoperatively had a 22% rate of refracture” (12 patients) compared with four patients in the operative group.
“This has to be weighed against the fact that 27% of operatively treated patients required a second surgery for removal of surgical implants,” Ames said.
Researchers found patients with a nonoperative refracture spent a total time away from full activities of 141.9 days vs. 91.1 days for patients without a refracture, while patients with an operative refracture spent a total time away from full activities of a mean of 208.3 days vs. 91.2 days for patients without a refracture. The QuickDASH survey revealed 17 of 22 patients in the nonoperative group and 22 of 25 patients in the operative group reported no disability, according to results.
“We hope that our study can help aid in the shared decision-making process with patients and families when deciding on operative vs. nonoperative treatment of displaced pediatric clavicle fractures,” Ames said.
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