The Operative Outcomes of Displaced Distal Clavicle Fractures in Adolescents

Distal clavicle fractures in skeletally immature patients are rare injuries, accounting for 3.8% of all clavicle fractures in this population. Optimal management of significantly displaced fractures is not clear from the literature. Some authors favor nonoperative treatment, despite significant displacement, citing the osteogenic nature of the periosteal sleeve providing significant potential for remodeling. Others have advocated operative treatment, especially in athletes. This study investigates the functional outcomes of patients undergoing operative fixation of these fractures. We present our preferred surgical technique, which is reproducible and does not require a routine second operation to remove hardware. We investigated 36 skeletally immature patients with significantly displaced distal third clavicle fractures. All were treated surgically using the same operative technique. Outcomes included time to union and Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months. Mean age at time of injury was 14.2 years. Most injuries were sustained while playing a contact sport. Mean time to union was 6.7 weeks. The mean DASH score at 12 months was 3.9. There was 1 complication relating to an adverse reaction to suture material. There were no cases of clavicular shortening or duplication. Operative fixation of displaced distal third clavicle fractures using the technique presented here results in excellent clinical and radiographic outcomes in this age group.
Level of Evidence: Level IV—case series.