Document Type

Conference Proceeding

Publication Date

4-10-2025

Abstract

OBJECTIVE: Clavicle fractures are common in both adult and pediatric populations.1 Yet, the literature describes differences regarding treatment in such fractures between these populations, favoring operative treatment for adults and nonoperative treatment for pediatric patients.2 There is particular uncertainty for treating a subgroup of adolescent clavicle fractures known as the Z-type comminuted fracture which, being a completely displaced and complex fracture pattern, can prove to have different healing rates than other midshaft clavicle fractures. Because of concerns about healing and bony prominences, these types of fractures are commonly treated surgically, despite an increasing body of literature indicating equivalent outcomes in treating adolescent clavicle fractures surgically or nonsurgically.3 However, there is still some controversy in the literature regarding appropriate treatment of completely displaced adolescent clavicle fractures.4 Thus, this study aims to determine outcome differences between surgical or non-surgical treatment for adolescent Z-type fractures and to ascertain if differences exist in patient-reported outcomes between the two interventions. METHODS: A retrospective chart review was conducted of 78 patients at Beaumont Royal Oak Hospital from 01/01/2019 to 12/31/2022. Inclusion criteria included patients between ages 12 and 16, diagnosis of a Z-type comminuted fracture, in-patient admission with surgical treatment, and out-patient cases treated nonsurgically. Data collected included demographics, treatment modality, union achievement, follow-up period, return to activity, range of motion, and patient-reported pain. A preliminary chi-squared test was performed to compare outcomes between treatment groups. RESULTS: Based on preliminary statistical analysis, 21 patients underwent surgery while the remaining 57 did not. A total of 54 patients either did not follow-up or their follow-up was not present in any charts. 3 patients experienced non-union: 2 non-surgical, 1 surgical (p = .798514). Every patient who continued to follow-up was able to return to normal activity, regained normal ROM, and reported minimal to no lingering pain with an average follow-up time of 7.5 months. CONCLUSIONS: The study found no significant difference in adverse outcomes between surgical and non-surgical treatments for adolescent Z-type comminuted fractures. Non-union rates did not significantly vary between groups, suggesting no superior treatment option. Further research tracking patients longitudinally is needed for comprehensive understanding.

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Mid-America Orthopaedic Association 42nd Annual Meeting, April 9-13, 2025, San Antonio, TX

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