Variation in Treatment Approaches to Adolescent Midshaft Clavicle Fractures in Pediatric Versus Adult Hospitals

Objective: The primary objective of this study was to identify differences in the treatment approach for isolated, displaced midshaft clavicle fractures in adolescent patients 15-18 years of age at adult versus pediatric hospitals. The secondary objective of this study was to identify factors associated with the surgical treatment of these fractures in this age group. Design: Retrospective cohort study. Setting: Two adult and one pediatric tertiary care referral hospitals. Patients/Participants: Adolescent patients 15-18 years of age with isolated, displaced midshaft clavicle fractures treated at 2 adult tertiary care referral hospitals and one pediatric tertiary care referral hospital were identified. A total of 214 patients, 105 from the adult hospitals and 109 from the pediatric hospital, were included. Intervention: Nonoperative versus surgical treatment of clavicle fractures. Main Outcome Measurement: Surgical treatment. Results: A multivariable logistic regression analysis showed that superior-inferior fracture displacement [odds ratio (OR) 1.13, 95% confidence interval (CI) 1.06-1.20], dominant upper extremity injury (OR 2.60, 95% CI 1.19-5.67), and treatment at an adult hospital (OR 5.28, 95% CI 2.28-12.2) were independently associated with the surgical treatment of adolescent displaced midshaft clavicle fractures. Conclusions: After controlling for relevant demographic and fracture characteristics, adolescent patients treated at adult hospitals for displaced midshaft clavicle fractures have more than 5 times the odds of surgical treatment than those treated at a pediatric hospital. Significant practice variation across institutions reflects ongoing controversy in surgical indications and underscores the need for high-quality prospective outcome studies.

Automated summary

The study aimed to identify differences in treatment approaches between adult and pediatric hospitals for isolated, displaced midshaft clavicle fractures in adolescents aged 15-18. Factors associated with surgical treatment in this age group were also examined. Results revealed that superior-inferior fracture displacement, dominant upper extremity injury, and treatment at an adult hospital were independently associated with surgical treatment for adolescent patients with displaced midshaft clavicle fractures.