» Results of Fractures of the Collar Bone in Teens Treated Without Surgery
Results of Fractures of the Collar Bone in Teens Treated Without Surgery

Children, adolescents (teenagers), and adults are all groups who sustain a clavicular fracture (clavicular refers to the collar bone). A bone break in the middle of the clavicle with displacement (separation of the fracture) can result in a shortened, misaligned clavicle. This particular deformity in adults has been shown to create abnormal biomechanical stresses throughout the entire upper quadrant (e.g., shoulder joint, shoulder blade, clavicle).

Surgery may be needed to realign the ends of the bone and reduce long-term disability. In fact, with adults, surgery does produce better results and greater patient satisfaction compared with conservative (nonoperative) care. And studies have confirmed that without surgical correction, many patients with displaced clavicle fractures end up with a nonunion, displaced, shortened bone.

The question naturally arises: what happens in teens with this type of injury who are treated nonoperatively? Can they regain normal motion and strength? Can those who are athletes return to a level of full pre-injury sports participation? The results of this study suggest "yes" to all of those questions.

There were sixteen adolescents enrolled in the study in a 4:1 ratio of males to females (i.e., 12 males and 4 females). The majority of teens (13 of the 16) broke the clavicle on the nondominant side.

Treatment was with the arm on the affected side in a sling until X-rays showed healing had occurred. Measurements were taken before and after treatment of shoulder motion, length of the clavicle (fractured bone compared to the other side), and strength (isometric muscle testing). Each of these measurements was compared to the normal side.

There were very few differences after treatment between the fractured side and the uninvolved arm. Slight differences were noted in external rotation strength and abduction endurance. Despite changes in the length (longer or shorter) of the clavicle on the fractured side, there was a 100 per cent rate of union (healing of the two fractured ends of the clavicle).

Only one of the 16 patients was unhappy with the results and that was because that particular person still had shoulder pain. And everyone returned to their full activity level, even those who were involved in sports.

The results of this study support Mercer Rang's axiom, If the two ends of the clavicle are in the same room, they will heal. Reliable healing with few long-term symptoms is possible and even probable because the bone will remodel successfully in this age group. There is a minimal loss of strength due to biomechanical changes in clavicular length. This has the potential to put stress on the joints of the shoulder and decrease the force generated by the muscles for strength. Even so, these teens were still able to function fully in all daily and sports activities.

If surgery can be avoided with conservative care only, it may be possible to eliminate complications such as numbness from the incision and/or infection. Likewise, with conservative care, there is no need for fixation with metal plates or other hardware that may need to be removed later in a second surgery. This study confirmed that the nonoperative approach can be successful with midshaft clavicle fractures in teens.

Reference: Jacob Schulz, MD, et al. Functional and Radiographic Outcomes of Nonoperative Treatment of Displaced Adolescent Clavicle Fractures. In The Journal of Bone and Joint Surgery. July 3, 2013. Vol. 95A. No. 13. Pp. 1159-1165.