Good afternoon, everyone. My name is Sammy Polinsky, and today I'll be talking about this paper, the prospective study done at Ready Children's in San Diego. These are my co-authors, and we have no disclosures. Clavicle fractures are quite common, about 90% of them occurring in the midshaft, and of those, 50% are completely displaced. So a sound treatment algorithm is very important, and the clavicles in these adolescents tend to have trended with the adults and have been grouped into that literature due to the limited amount of data in this teenage population, and the data that does exist tends to be retrospective and short-term. But we know that adolescents tend to heal better than our adult counterparts, in part from fracture remodeling. From a paper in 2020 which showed that clavicles grow until the age of 25, and that even in our 16- to 19-year-old adolescents, we have about 2-3 millimeters of growth based on whether you're male or female. So our study attempted to prospectively evaluate these adolescents that were treated nonoperatively five years from injury and to quantify the amount of remodeling that occurred and see if there's any association or correlation with our Functional Outcome Scores. So we took a subset of a multi-center cohort, looked at just our single institution, and after inclusion criteria, ended up with 24 patients who we assessed. We provided surveys and included return to sport and cosmetic satisfaction assessments, and also did a physical exam in clinic. We took radiographs and compared the initial AP view of the unilateral clavicle to a bilateral AP view five years out from injury, and looked at three parameters which we measured, shortening superior displacement, and angulation, and compared the differences over the five years. We also classified the amount of remodeling which occurred and categorized it in one of three categories, complete to near-complete, moderate, and minimal. So our cohort, which had 24 patients, had an average age of about 15 with a range of 13 to 17.5. They were predominantly male, had open physes, and were considered athletes at the time of injury, and the follow-up ended up being about six years. Our long-term PROs were notable for an ACES score of 99 on average, but excellent functional outcome scores down the line, including satisfaction with appearance and overall function. And everyone who wanted to return to their sport did in fact return to their sport. With regard to the physical exam that was conducted, full range of motion in almost every patient with limited internal rotation in one patient, but no strength deficits, no scapular dyskinesia, and no patient required surgery or PT for a malunion. Only one patient had some mild numbness at the fracture site. With regard to the remodeling measurements, we had significant improvement across all three parameters with shortening, superior displacement, and angulation showing 70%, 73%, and 83% improvement respectively. And 72% of our cohort had shortening greater than 2 centimeters, but all of those patients remodeled to less than 2 centimeters. With regard to the classification, 82% of our patients had complete to near-complete remodeling and no one experienced minimal remodeling. We did not in fact establish any kind of association or correlation with any one individual PRO from the remodeling data. The limitations to this study, there are three big ones. The first is that it's a pretty small subset. In part there's some selection bias at play with patients who we lose to follow-up, especially in the older population where they might have gone off to college or changed numbers, hard to contact them. The second is about the older population. The oldest patient we had was about 17 and a half. It would be nice to study the 16 to 19-year-age adolescent, especially since they have that 2 to 3 millimeter left of growth. And lastly, we didn't have a comparison study, no control nor an operative group. But the results of this study are still pretty consistent and convincing given the ACES functional scores and the radiographic imaging with remodeling that we saw. And so in conclusion, we had nearly perfect results from our non-operative group that experienced substantial remodeling with over 80% undergoing complete to near-complete remodeling. And this really kind of hits at the difference between our adults and our adolescents and shows us that more data needs to go into this age group so that we can choose treatment appropriately. Thank you so much.

clavicle fractures

adolescents

prospective study

remodeling

functional outcome scores