Clavicle Fractures in Adolescents: What are the FACTS?

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Fractured collarbones. When I first started my career, the party line for a fractured clavicle was if both ends of the collarbone were in the same state, it will heal fine, and let them be. Then it seemed like there was a push to treat more clavicle fractures surgically, even in the pediatric and adolescent population. But was that really the right way to go? Was our previous thinking incorrect? Today on the podcast I have two physicians who are part of the FACTS (Function After Adolescent Clavicle Trauma and Surgery) multicenter study group who will let us know what they’ve found about pediatric and adolescent clavicle fractures.

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Links from this Episode:

— Dr. Mark Halstead: On the Web — On Twitter

— Dr. Benton Heyworth: – On the Web: https://www.childrenshospital.org/directory/benton-heyworth

— Dr. Jeffrey Nepple: – On the Web: https://www.ortho.wustl.edu/content/Patient-Care/3648/Find-a-Physician/Physician-Directory/Jeffrey-Nepple-MD-MS/Bio.aspx

— Ellis HB, Li Y, Bae DS, Kalish LA, Wilson PL, Pennock AT, Nepple JJ, Willimon SC, Spence DD, Pandya NK; FACTS Study Group; Kocher MS, Edmonds EW, Farley FA, Gordon JE, Kelly DM, Busch MT, Sabatini CS, Heyworth BE. Descriptive Epidemiology of Adolescent Clavicle Fractures: Results From the FACTS (Function after Adolescent Clavicle Trauma and Surgery) Prospective, Multicenter Cohort Study. Orthop J Sports Med. 2020 May 29;8(5):2325967120921344. doi: 10.1177/2325967120921344. PMID: 32528990; PMCID: PMC7263158. https://pubmed.ncbi.nlm.nih.gov/32528990/

— Li Y, Donohue KS, Robbins CB, Pennock AT, Ellis HB Jr, Nepple JJ, Pandya N, Spence DD, Willimon SC, Heyworth BE; Function After Adolescent Clavicle Trauma and Surgery (FACTS) Multicenter Study Group. Reliability of Radiographic Assessments of Adolescent Midshaft Clavicle Fractures by the FACTS Multicenter Study Group. J Orthop Trauma. 2017 Sep;31(9):479-484. doi: 10.1097/BOT.0000000000000877. PMID: 28471918. https://pubmed.ncbi.nlm.nih.gov/28471918/

— Pennock AT, Heyworth BE, Bastrom T, Bae DS, Boutelle KE, Busch MT, Edmonds EW, Ellis HB, Hergott K, Kocher MS, Li Y, Liotta ES, Pandya NK, Perkins C, Sabatini CS, Spence DD, Willimon SC, Wilson PL; FACTS Study Group; Nepple JJ. Changes in superior displacement, angulation, and shortening in the early phase of healing for completely displaced midshaft clavicle fractures in adolescents: results from a prospective, multicenter study. J Shoulder Elbow Surg. 2021 Dec;30(12):2729-2737. doi: 10.1016/j.jse.2021.05.006. Epub 2021 Jun 2. PMID: 34089880.https://pubmed.ncbi.nlm.nih.gov/34089880/

— Heyworth BE, Pennock AT, Li Y, Liotta ES, Dragonetti B, Williams D, Ellis HB, Nepple JJ, Spence D, Willimon SC, Perkins CA, Pandya NK, Kocher MS, Edmonds EW, Wilson PL, Busch MT, Sabatini CS, Farley F, Bae DS. Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group. Am J Sports Med. 2022 Sep;50(11):3045-3055. doi: 10.1177/03635465221114420. Epub 2022 Aug 19. PMID: 35984091.https://pubmed.ncbi.nlm.nih.gov/35984091/

— Pennock AT, Bastrom TP, Boutelle KE, Carroll AN, Edmonds EW, Nepple JJ, Polinsky SG, Spence DD, Perkins C, Willimon SC, Bae DS, Busch MT, Ellis HB, Hergott K, Kocher MS, Li Y, Pandya NK, Sabatini CS, Wilson PL; FACTS Study Group; Heyworth BE. Bony Remodeling of Adolescent Displaced Clavicle Fractures: A FACTS Study. Am J Sports Med. 2023 Mar;51(4):871-876. doi: 10.1177/03635465231152884. Epub 2023 Feb 20. Erratum in: Am J Sports Med. 2023 Apr 11;:3635465231168388. PMID: 36802767. https://pubmed.ncbi.nlm.nih.gov/36802767/

— Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007 Jan;89(1):1-10. doi: 10.2106/JBJS.F.00020. PMID: 17200303. https://pubmed.ncbi.nlm.nih.gov/17200303/

— Altamimi SA, McKee MD; Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone Joint Surg Am. 2008 Mar;90 Suppl 2 Pt 1:1-8. doi: 10.2106/JBJS.G.01336. PMID: 18310682. https://pubmed.ncbi.nlm.nih.gov/18310682/

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The Host of this Program:

Mark Halstead:

Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine.

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The Guests Featured Inside this Program:

Benton Hayworth:

Dr. Benton Heyworth is an Associate Professor in Orthopedic Surgery at Harvard Medical School, an Attending Orthopedic Surgeon in the Division of Sports medicine at Boston Children’s Hospital, where he is the Associate Director of the Sports Medicine Fellowship Program. He completed his undergraduate degree at Princeton, followed by medical school at Columbia University and then his orthopedic surgery residency at the Hospital for Special Surgery in New York. He then completed two fellowships, the first in sports medicine at Massachusetts General Hospital and the second in Pediatric Orthopedic Surgery at Boston Children’s. He is part of several multicenter research studies and has served as the Chair of the Research Committee and Director-at-Large in the Board of Directors for PRiSM and member of multiple committees for POSNA.

Jeffrey Nepple:

Dr. Jeffrey Nepple is a pediatric sports medicine orthopedic surgeon who received his medical degree from and completed his orthopedic residency at Washington University School of Medicine in St Louis. He then completed his fellowship in Sports Medicine at the Steadman Clinic as well as a pediatric orthopedic fellowship at Washington University. He is a member of numerous medical societies and has clinical interest in pediatric knee disorders and research interests in young adult hip disorders and pediatric sports medicine. He also currently serves on the Board of Directors for PRiSM.

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