Pediatric clavicular fractures: assessment of fracture patterns and predictors of complicated outcome
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Benjamin Jacob Strauss1, Timothy P Carey, Jamie A Seabrook
1Schulich School of Medicine, the University of Western Ontario, London, Ontario, Canada.
Insights
Pediatric clavicular fractures rarely lead to complications, but advanced age and complete displacement significantly increase risk. Emergency physicians can use these factors to identify children needing closer monitoring for better outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric emergency medicine
- Radiology
Background:
- Clavicular fractures are the most common long-bone fracture in children.
- While most pediatric clavicular fractures heal well, complications can cause pain and disability.
- Limited research exists on complication rates and risk factors in pediatric populations compared to adults.
Purpose of the Study:
- To identify radiological and clinical variables associated with increased complication rates in pediatric clavicular fractures.
- To aid emergency physicians in identifying pediatric patients requiring enhanced follow-up or surgical intervention.
Main Methods:
- Retrospective analysis of 537 pediatric clavicular fractures over a 4-year period.
- Radiographic variables (displacement, angulation, comminution) and demographic data (age, gender) were collected.
- Logistic regression analysis was used to determine variables associated with complications.
Main Results:
- Only 2.5% of non-operatively treated fractures resulted in complications.
- Increasing patient age was an independent predictor, with each year increasing complication risk by 18.1%.
- Completely displaced fractures increased the odds of complication by a factor of 3.2.
Conclusions:
- Emergency physicians can identify high-risk pediatric patients with clavicular fractures.
- Thorough follow-up should be considered for pediatric patients with risk factors such as advanced age and complete displacement.
Background:
Clavicular fractures are the most common pediatric long-bone fracture, and although the vast majority heal with supportive treatment, complications do occur and can lead to pain and disability. Although many studies have characterized adult complication rates and risk factors, to our knowledge no comparable studies to date have looked at clavicular fractures in the pediatric population.
Study Objectives:
The study aim was to identify the radiological and clinical variables that increase the complication rate of clavicular fractures. Identification of these variables would help emergency physicians identify patients who require more thorough follow-up or surgical intervention.
Methods:
We analyzed radiographs of 537 clavicular fractures on initial presentation to the Pediatric Emergency Department at the Children's Hospital at London Health Sciences Center over a 4-year period, collecting data on variables such as displacement, angulation, and comminution, as well as demographic data such as age and gender. We then determined the outcome of each fracture by reviewing each patient's chart, and through a logistic regression analysis, determined the variables associated with complications.
Results:
Of all the fractures treated supportively (i.e., non-operatively), only 2.5% resulted in a complication. Our analysis determined that patient age was an independent predictor of complications, with each year past zero conferring an 18.1% increase in risk of complication. Furthermore, completely displaced fractures were shown to increase the odds of complication by a factor of 3.2.
Conclusion:
These findings help the emergency physician identify a group of high-risk pediatric patients with clavicular fractures for which more thorough follow-up should be considered.
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