University of Oulu

Sassi, E., Hannonen, J., Serlo, W. et al. Increase in surgical fixation of pediatric midshaft clavicle fractures since 2008. BMC Musculoskelet Disord 23, 173 (2022).

Increase in surgical fixation of pediatric midshaft clavicle fractures since 2008

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Author: Sassi, Elina1,2; Hannonen, Juuli1; Serlo, Willy1;
Organizations: 1Department of Children and Adolescents, Oulu University Hospital, Oulu Childhood Fracture and Sports Injury Study, Medical Research Center Oulu, PEDEGO Research Group, University of Oulu, Oulu, Finland
2Department of Children and Adolescents, Oulu University Hospital, POB 23, 90029 OYS, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.8 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2022-05-20


Background: Clavicle fractures in children have traditionally been treated non-operatively. In adults, a great increase in operative treatment has been reported. We aimed to analyze the respective trend and potential explanatory factors in children.

Methods: This is a single-institution retrospective study in a subregion in Northern Finland. The ICD-code S42.0 was used to identify the cases in the hospital registry. Altogether, 214 children, aged < 16, with consecutive clavicle fractures were first enrolled in the area during 2008–2019. Hospital journals and radiographs were reviewed. After lateral and medial fractures and patients living outside the area were excluded, final study population was 172. The respective population at risk was extracted by Statistics Finland. Predictive factors and annual rates of operative treatment as adjusted for 100,000 children at risk were determined.

Results: The rate of the surgical treatment of clavicle fractures increased from zero in 2008 to 10.8 in 2019 per 100,000 age-adjusted children (β = 0.864, 95% confidential intervals (CI) 0.4 to 1.4). There was a rise in the rate of surgery from 2.6% (2014–16) to 16.1% (2017–19) (diff. 13.5, 95% CI 1.7 to 23.3%). A displacement > 15 mm and a shortening of > 15 mm were associated with the increased risk of surgery but did not change during the study period. Age > 9 years increased the risk of surgery; the mean age increased from 5.5 years (2008–10) to 8.5 years (2017–19). There was a 3.6-fold increase in sports-related fractures (95% CI 7.4 to 26.4). The severity of the fractures did not change.

Conclusions: There has been an increasing trend in the surgical fixation of pediatric middle shaft clavicle fractures since 2008. The available literature does not support the trend.

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Series: BMC musculoskeletal disorders
ISSN: 1471-2474
ISSN-E: 1471-2474
ISSN-L: 1471-2474
Volume: 23
Article number: 173
DOI: 10.1186/s12891-021-04918-x
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3126 Surgery, anesthesiology, intensive care, radiology
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