Changes in Fracture Shortening Occur in the First 2 Weeks Following Completely Displaced Adolescent Clavicle Fractures.

Background: Shortening of midshaft clavicle fractures has been described as a critical fracture characteristic to guide treatment. The degree to which shortening may change in the initial weeks following injury has not been well studied. The purpose of this study was to evaluate the change in shortening of adolescent clavicle fractures in the first 2 weeks following injury.
Methods: This was a multicenter study of prospectively collected data, which was acquired as a part of a cohort study of adolescent clavicle fractures. A consecutive series of patients 10 to 18 years of age with completely displaced diaphyseal clavicle fractures with baseline radiographs 0 to 6 days from the date of injury, as well as 7 to 21 days from the date of injury, were included. Measurements of end-to-end (EES) and cortex-to-corresponding-cortex (CCS) shortening were performed.
Results: A total of 142 patients were included. Baseline radiographs were obtained at a mean of 1.0 day following injury with mean EES of 22.3 mm, and 69% of patients demonstrating > 20 mm of shortening. Follow-up radiographs obtained at a mean of 13.8 days postinjury demonstrated a mean absolute change in EES of 5.4 mm. Forty-one percentage of patients had >5 mm of change in EES. When analyzing changes in shortening relative to the specific threshold of 20 mm, 18 patients (41%) with <20 mm EES increased to ≥20 mm EES, and 19 patients (19%) with ≥20 mm EES decreased to <20 mm EES at 2-week follow-up.
Conclusions: Clinically significant changes in fracture shortening occurred in 41% of adolescents with completely displaced clavicle fractures in the first 2 weeks after injury. In 26% of patients, this resulted in a change from above or below the commonly used shortening threshold of 20 mm, potentially altering the treatment plan by many providers. There is no evidence to suggest that adolescent clavicle fracture shortening affects outcomes, and as such, the authors do not advocate for the use of this parameter to guide treatment. However, among physicians who continue to use this parameter to guide treatment, this study supports that repeat radiographic assessment 2 weeks postinjury may be a better measure of the true shortening of this common adolescent injury.
Level of Evidence: Level IV-case series.
Competing Interests: J.J.N. discloses speaking fees from Smith & Nephew; consulting fees from Ceterix Orthopaedics, Smith & Nephew, and Responsive Arthroscopy; educational support from Arthrex and Elite Orthopedics. J.J.N. is also a consultant with Ceterix Orthopaedics, Smith & Nephew, and Responsive Arthroscopy. E.W.E. discloses fees received from Orthopediatrics and Arthrex Corporation for speaking/organizing an educational program. H.B.E. discloses speaking fees from Smith & Nephew and Synthes GmbH, speaking fees from Orthopaediatric, educational support from Pylant Medical, and hospitality payments from Arthrex. M.S.K. discloses consulting fees and royalties from OrthoPediatrics, speaking fees and honoraria from Stryker, and educational support from Kairos Surgical. M.S.K. is also a consultant with OrthoPediatrics, Smith & Nephew, and Ossur. Y.L. discloses educational support from Zimmer/Biomet. Y.L. is also on the advisory board for Medtronic. N.K.P. discloses consulting fees from OrthoPediatrics and educational support from Evolution Surgical. N.K.P. is also a consultant with OrthoPediatrics. A.T.P. discloses speaking fees from Smith & Nephew, consulting fees from OrthoPediatrics, and educational support from Sporstek Medical. A.T.P. also owns stock or stock options in Imagen Technologies and receives publishing royalties and financial or material support from Wolters Kluwer Health–Lippincott Williams & Wilkins. A.T.P. also is a consultant with OrthoPediatrics. D.D.S. discloses educational support from Gentleman Orthopedic Solutions. S.C.W. discloses speaking fees from Arthrex and Smith & Nephew and consulting fees from Smith & Nephew. S.C.W. also is a consultant with Smith & Nephew. P.L.W. discloses educational support from Pylant Medical. B.E.H. discloses educational support from Kairos Surgical and consulting fees from Arthrex Inc. The remaining authors declare no conflicts of interest.
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