Treatment of clavicle fractures in adolescents

Clavicle fractures constitute 10% to 15% of all fractures in adolescents. Historically, adolescent clavicle fractures have been treated non-operatively. Although recent data in the adult population has led to an increased rate of operative fixation in the adolescent population, a vast majority of these fractures in adolescents can be managed conservatively. This manuscript provides an overview of the current standard of care for clavicular fractures in adolescents in the context of sports medicine practices. To achieve this, a nonsystematic search of computerized databases of peer-reviewed articles was conducted, and a critical appraisal of existing literature was subsequently performed. Middle third clavicle fractures are by far the most common type and a vast majority of these fractures can be treated non-operatively with a sling given the robust healing and remodeling seen in adolescents. Lateral third fractures are far less common but may pose a risk for nonunion according to adult literature. Medial third fractures are the least common type and while they are typically non-displaced, patients with posteriorly displaced medial third fractures must have concomitant intrathoracic injury ruled out. Additionally, timing of the injury relative to competitive season could play a role in decision making as surgical fixation of clavicle fractures has been shown to yield faster return to play times.