Trends In The Volume Of Operatively Treated Mid-shaft Clavicle Fractures In Children And Adolescents

OBJECTIVES: Clavicle fractures are common in children and adolescents and are traditionally treated nonoperatively. With youth sports participation increasing in popularity, including contact sports, the frequency of such injuries may be increasing. The purpose of this study was to examine institutional trends in the volume of operative plate fixation for mid-shaft clavicle fractures in children and adolescents. METHODS: Medical records, identified through a departmental database and cross-referenced for accuracy against billing records using ICD-9 codes, were retrospectively reviewed to identify otherwise healthy 10-18 years-olds who presented with a clavicle shaft fracture between 1999-2011 at a single tertiary-care pediatric hospital. Demographic data, fracture characteristics and treatment details were analyzed. Radiographic review of operative cases was used to confirm fracture location and surgical implant. Annual volumes were determined for the overall number of clavicle fractures, mid-shaft clavicle fractures, and mid-shaft fractures that underwent operative plate fixation. Additionally, the annual rate was determined for the number of operative cases among all mid-shaft fractures. Kendall’s Tau-b was used to assess the relationship between case volume and time. RESULTS: From 1999-2011, a total of 882 patients were seen at our institution with a diaphyseal clavicle fracture (mean age: 14.3), 644 (73%) of which were mid-shaft. Of these 644, 111 were treated with operative plate fixation (mean age: 15.9). There was a significant increase in the number of mid-shaft clavicle fractures seen annually over that period, from 20/yr to 85/yr (r=0.80, p<0.0001). The percent of mid-shaft clavicle fractures treated with plate fixation also increased significantly from 5% to 25% (r=0.84, p<0.0001) while the rate of mid-shaft fractures among all diaphyseal fractures remained more stable. Among the mid-shaft fracture cases that received operative plate fixation, 53.2% presented with fractures received during a competitive sporting event. CONCLUSION: The volumes of clavicle fractures and of mid-shaft clavicle fractures treated operatively appear to be increasing. Additionally, despite a lack of evidence based support, the frequency of operative plate fixation of mid-shaft clavicle fractures appear to be increasing in the pediatric population. Many of these fractures are of a sports-based etiology.