Is There a Deficit after Nonoperative Versus Operative Treatment of Shortened Midshaft Clavicular Fractures in Adolescents?

Background: Recent clinical studies in adults have reported a higher incidence of symptomatic malunions and functional deficits in nonoperatively treated shortened midshaft clavicular fractures. We sought to determine whether functional or subjective deficits are found in adolescents after operative versus nonoperative treatment of clavicle fractures. Methods: Adolescents with displaced midshaft clavicle fractures, >15 mm of shortening, and a minimum of 9 months of follow-up were recruited. Exclusion criteria included concomitant upper extremity injuries or abnormalities that would affect biomechanical strength testing. Sixteen patients, equally divided between nonoperative and operative plate fixation, met inclusion criteria and consented to testing. The average age (±SD) at the time of injury was 14±2 years (range, 10 to 16 y), time from injury was 22±10 months (range, 10 to 41 mo), and shortening was 24±6 mm (range, 16 to 35 mm). Consenting subjects completed a QuickDASH Score, Constant Shoulder Score, and questions regarding satisfaction with treatment. Quantitative isometric strength, range of motion, and abduction fatigue testing was performed on the involved and uninvolved sides for comparison. Results: Treatment groups did not differ in age, time from injury, or fracture shortening. QuickDASH and Constant Shoulder Scores were perfect in all but 1 patient in the operative group who actively complained of persistent symptomatic hardware. This patient and one other in the operative group underwent symptomatic hardware removal. There were no cases of symptomatic malunions in the nonoperative group. All patients expressed satisfaction with their treatment. Two in each treatment group were unsatisfied with the appearance of the clavicle. With the exception of a 3% decrease in abduction strength in the operative group (P=0.03) there were no differences in range of motion, isometric strength, or abduction fatigue of the involved shoulder in either treatment group. Conclusions: Shortened midshaft clavicular fractures had excellent outcomes after both operative and nonoperative treatments. No subjective or objective differences were observed between treatment groups. Level of Evidence: Level III - therapeutic, retrospective comparative study.