Elastic stable intramedullary nailing for displaced pediatric clavicle midshaft: A prospective study of the results and patient satisfaction in 24 children and adolescents aged 10 to 15 years fractures

Background: Whereas displaced clavicle fractures in young children are treated nonoperatively, older children are more likely to suffer persistent pain and misalignments during a longer period of treatment. This study presents the outcomes of elastic stable intramedullary nailing for displaced clavicle fractures in children over the age of 10. Methods: Prospectively, this study evaluates elastic stable intramedullary nailing for displaced clavicle midshaft fractures in children and adolescents, aged 10 to 15 years, from July 2004 to June 2010. We analyzed all complications, patient pain and long-term results, measured using the Constant & Murley Shoulder Score, the Client Satisfaction Questionnaire-8, and ultrasound. Results: Eight girls and 16 boys (aged 10 to 15 y), 1 with bilateral fracture, were recruited. Sixteen mini-open reductions were necessary. All adolescents reported full mobilization from the first postoperative day, full activity after 1 week, and sporting activity after 1 month. Self-reported pain was very low. Five complications occurred: 1 implant breakage (kick-boxing); 2 nail deformations (fall during football, collision in ice-hockey); and 2 imminent skin perforations. The mean Constant & Murley Shoulder Score at follow-up after 1 year was 99.5 of 100 points; the mean patient satisfaction in the Client Satisfaction Questionnaire-8 was 30.6 of 32 points. Axial deviation of the clavicle was always <10 degrees; shortening <0.5 cm. Conclusions: Elastic stable intramedullary nailing can be offered for displaced midshaft clavicle fractures in children older than 10 years. They benefit from little pain, early mobilization, and fast full range of motion. To avoid complications the maximum projection of the ends of the nails must be 5 mm; no sports should be allowed for 4 weeks, contact sports for 8 weeks. Level of EvidenceE: Level IV.