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Functional and radiographic outcomes of nonoperative treatment of displaced adolescent clavicle fractures.

BACKGROUND
Studies of adult patients suggest that nonoperative treatment of clavicle fractures may result in functional disability, but this has not been demonstrated in adolescents. The purpose of this study was to determine the functional outcomes after nonoperative treatment of displaced, shortened, midshaft clavicle fractures in adolescents.


METHODS
Adolescents ten to eighteen years of age with an isolated, completely displaced, shortened, midshaft clavicle fracture sustained between 2009 and 2011 were recruited for this study. Injury and final radiographs were assessed for displacement, shortening, and clavicle length. Maximal and endurance strength testing was performed with the Baltimore Therapeutic Equipment (BTE) machine, with use of the uninjured shoulder as an internal control. Shoulder range of motion and clavicle length were assessed clinically, and patient-oriented outcomes were obtained.


RESULTS
Sixteen patients (four of whom were female) with an average age (and standard deviation) of 14.2 ± 2 years and a mean duration of follow-up of 2 ± 1 years were included in the study. Fifteen patients were right-hand dominant and one was ambidextrous, and thirteen of the fractures occurred in the nondominant limb. Compared with the uninjured limb, no differences were noted in range of motion or strength except for an 8% decrease in maximal shoulder external rotation strength (p = 0.04) and a 11% loss of shoulder abduction endurance strength (p = 0.04). Radiographs demonstrated a 100% union rate but significant shortening compared with the uninjured clavicle (p ≤ 0.001). SANE (Single Assessment Numeric Evaluation), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire), and Constant scores were similar between sides. Fifteen of the sixteen patients were satisfied with the appearance of the clavicle, and all returned to full activity, including the preinjury (or a higher) level of sports participation.


CONCLUSIONS
Regardless of patient age, sports participation, and final clavicle shortening, no differences in pain, strength, shoulder range of motion, or subjective outcome scores were found between the injured and uninjured limbs of adolescents treated nonoperatively for a displaced, shortened, midshaft clavicle fracture.