Open reduction and internal fixation of displaced clavicle fractures in adolescents

The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years) with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes(®) LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH), the simple shoulder test (SST) and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0-35.5) and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9-12). All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12-17 weeks). Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands.