Pediatric clavicular fractures: assessment of fracture patterns and predictors of complicated outcome.

BACKGROUND

Clavicular fractures are the most common pediatric long-bone fracture, and although the vast majority heal with supportive treatment, complications do occur and can lead to pain and disability. Although many studies have characterized adult complication rates and risk factors, to our knowledge no comparable studies to date have looked at clavicular fractures in the pediatric population.

STUDY OBJECTIVES

The study aim was to identify the radiological and clinical variables that increase the complication rate of clavicular fractures. Identification of these variables would help emergency physicians identify patients who require more thorough follow-up or surgical intervention.

METHODS

We analyzed radiographs of 537 clavicular fractures on initial presentation to the Pediatric Emergency Department at the Children's Hospital at London Health Sciences Center over a 4-year period, collecting data on variables such as displacement, angulation, and comminution, as well as demographic data such as age and gender. We then determined the outcome of each fracture by reviewing each patient's chart, and through a logistic regression analysis, determined the variables associated with complications.

RESULTS

Of all the fractures treated supportively (i.e., non-operatively), only 2.5% resulted in a complication. Our analysis determined that patient age was an independent predictor of complications, with each year past zero conferring an 18.1% increase in risk of complication. Furthermore, completely displaced fractures were shown to increase the odds of complication by a factor of 3.2.

CONCLUSION

These findings help the emergency physician identify a group of high-risk pediatric patients with clavicular fractures for which more thorough follow-up should be considered.