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Variation in Treatment Approaches to Adolescent Midshaft Clavicle Fractures in Pediatric versus Adult Hospitals.

OBJECTIVE
The primary objective of this study was to identify differences in treatment approach for isolated, displaced midshaft clavicle fractures in adolescent patients 15 to 18 years of age at adult versus pediatric hospitals. The secondary objective of this study was to identify factors associated with surgical treatment of these fractures in this age group.


DESIGN
Retrospective cohort study SETTING:: Two adult and one pediatric tertiary care referral hospitalsPatients/Participants: Adolescent patients 15 to 18 years of age with isolated, displaced midshaft clavicle fractures treated at two adult tertiary care referral hospitals and one pediatric tertiary care referral hospital were identified. A total of 214 patients, 105 from the adult hospitals and 109 from the pediatric hospital, were included.


INTERVENTION
Nonoperative versus surgical treatment of clavicle fractures MAIN OUTCOME MEASUREMENT:: Surgical treatment RESULTS:: Multivariable logistic regression analysis showed that superior-inferior fracture displacement (OR 1.13, 95% CI 1.06 to 1.20), dominant upper extremity injury (OR 2.60, 95% CI 1.19 to 5.67), and treatment at an adult hospital (OR 5.28, 95% CI 2.28 to 12.2) were independently associated with surgical treatment of adolescent displaced midshaft clavicle fractures.


CONCLUSIONS
After controlling for relevant demographic and fracture characteristics, adolescent patients treated at adult hospitals for displacement midshaft clavicle fractures have more than 5 times the odds of surgical treatment than those treated at a pediatric hospital. Significant practice variation across institutions reflects ongoing controversy in surgical indications and underscores the need for high quality prospective outcomes studies.


LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.