Session VI - Pediatrics / Spine

Fri., 10/11/13 Pediatrics/Spine, PAPER #72, 4:19 pm OTA 2013

Refracture Rates Following Clavicle Shaft Fractures in Children: Angulation-Only Fractures Versus Completely Displaced Fractures

Michelle Masnovi, MS; Charles T. Mehlman, DO, MPH;
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Purpose: A growing body of literature has focused on completely displaced clavicle fractures, but there has been remarkably little attention focused on angulated fractures. The purpose of this study was to assess refracture rates following angulation only and completely displaced clavicle shaft fractures in children.

Methods: We performed computerized medical records searches aimed at identifying children treated for clavicle shaft fractures at our institution. Inclusion criteria were age less than 18 years and a minimum of 1 year radiographic follow-up. Statistical methods included Fisher’s exact test with significant probability values being defined as less than 0.05.

Results: We identified 121 angulation-only patients and 41 completely displaced patients that met the criteria to be included in our study. All fractures were treated nonsurgically. We identified a significantly higher (P = 0.008) refracture rate (18%, 22 of 121) in angulation-only fractures as compared to 0% (0 of 41) for completely displaced fractures. Subgroup analysis of the angulation-only fractures revealed that fractures angulated less than 40° refractured at a 26% rate (18 of 69) versus 8% (4 of 52) of fractures with greater angulation (P = 0.009).

Conclusion: We found that angulation-only shaft fractures had a significantly higher refracture rate than completely displaced fractures. Subgroup analysis demonstrated that less angulated fractures had a higher refracture rate than the more angulated ones. We feel this somewhat paradoxical finding is analogous to greenstick fractures of the forearm shaft that refracture at a higher rate than complete forearm shaft fractures due to less exuberant callus formation.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.