Pediatric refracture rates after angulated and completely displaced clavicle shaft fractures

J Orthop Trauma. 2014 Nov;28(11):648-52. doi: 10.1097/BOT.0000000000000135.


Objectives: The purpose of this study was to assess refracture rates after angulation-only and completely displaced clavicle shaft fractures in children.

Design: Retrospective chart review.

Setting: Level 1 pediatric trauma center.

Patients: Computerized medical records searches identified children treated nonoperatively for clavicle shaft fractures at our institution. Inclusion criteria were age less than 18 years and a minimum of 1-year radiographic follow-up. Statistical methods included Fisher exact test with significant probability values being defined as less than 0.05.

Results: Of the 120 angulation-only patients and 41 completely displaced patients meeting criteria for inclusion in our study, we identified a statistically higher (P = 0.002) refracture rate (18%, 21/120) in angulation-only fractures as compared with 0% (0/41) for completely displaced fractures. Subgroup analysis of the angulation-only fractures revealed that fractures angulated less than 40 degrees refractured at a 26% rate (18/69) versus 6% (3/51) of fractures with greater angulation (P = 0.004).

Conclusions: We found that angulation-only shaft fractures had a significantly higher refracture rate than completely displaced fractures. Furthermore, subgroup analysis demonstrated that less-angulated fractures had a higher refracture rate than the more-angulated ones. We feel this somewhat paradoxical finding is analogous to fractures of the forearm shaft, for which greenstick fractures refracture at a higher rate than complete forearm shaft fractures due to less-exuberant callus formation.

Level of evidence: Prognostic level III. See instructions for authors for a complete description of levels of evidence.

MeSH terms

  • Child
  • Child, Preschool
  • Clavicle / diagnostic imaging*
  • Clavicle / injuries*
  • Female
  • Fractures, Malunited / diagnostic imaging
  • Fractures, Malunited / epidemiology*
  • Fractures, Malunited / therapy*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Ohio / epidemiology
  • Radiography
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Treatment Failure