Long-term functional outcomes following non-surgical management of completely displaced midshaft clavicle fractures in adolescents (12–16 years): a retrospective cohort study with 11-year follow-up

INTRODUCTION: There is inconsistency in the management of adolescents with completely displaced clavicle fractures between surgical and non-surgical management. This study reviews the long-term need for additional surgery, functional and cosmetic outcomes following a predominantly non-surgical treatment protocol. METHODS: This was a retrospective single-centre cohort study of adolescents aged 12-16 years with midshaft clavicle fractures showing >1cm displacement or shortening. X-rays were reviewed by two researchers. At mean follow-up of 11.2 years (range 7.4-17.2) post injury functional outcomes were assessed using QuickDASH (qDASH) and Short Shoulder Test (SST) scores. Adolescents also reported shoulder cosmesis and global function compared with the contralateral side. RESULTS: = 0.015). One surgically treated patient required metalwork removal, and two in the non-surgical group underwent osteotomy for symptomatic mal-union. One refracture occurred in the non-surgical group and was treated conservatively. Median qDASH score was 1.1 (interquartile range [IQR] 0.0-4.0) and SST score was 100 (IQR 93.8-100) for the non-surgical group. A good appearance of the clavicle was reported by 20 (90.9%) treated with the non-surgical pathway with 21 (95.5%) reporting minimal self-consciousness. A good global rating compared with the uninjured shoulder was reported by 19 (86.4%). CONCLUSION: Non-surgical management of displaced adolescent clavicle fractures results in good functional and cosmetic outcomes with low rates of additional surgery. Surgical management showed no outcome advantage. We conclude non-surgical management should remain the standard treatment for this injury.