April 29, 2024
Warmer weather means more outdoor sports and activities. This could also mean an increased risk of sports-related fractures – one of the more common being clavicle, or collarbone, fractures. While any fracture can be scary, recent research by Jeffrey Nepple, MD, MS, and the FACTS Study Group is rethinking the standard approach to treating clavicle fractures, highlighting how effective non-surgical, conservative care can be in adolescent patients.
Clavicle fractures are most often caused by falls or collisions, and they almost always result in intense pain for the first few days. When a clavicle fracture occurs, the injured person is usually taken to an emergency room, urgent care facility, or Orthopedic Injury Clinic.
Doctors have traditionally treated clavicle fractures with surgery due to concerns about non-union - a condition where a fractured bone fails to heal completely, or malunion – a condition where fracture bone heals in a problematic alignment. Because of this concern, surgery for clavicle fractures has become increasingly common in adolescent patients over the last decade.
The Research
Enter the FACTS (Function after Adolescent Clavicle Trauma and Surgery) Study Group - a collaborative effort involving six academic medical centers, including WashU Ortho, with the goal of determining the optimal treatment approach for adolescent clavicle fractures. Dr. Nepple's role as a site principal investigator at WashU Ortho has been instrumental in shaping this research.
After nearly a decade of research, the FACTS research has produced groundbreaking insights, challenged conventional thinking, and reshaped clinical practice. One of the most significant findings is in the comparison of non-surgical and surgical treatment outcomes in adolescent clavicle fractures. Contrary to previous beliefs, most of these fractures heal well without surgical intervention and patients treated without surgery seem to be doing at least as well, if not better, than their adolescent counterparts that had surgery. “In most cases, the 'gut' reaction of patients, parents, and even physicians is that these injuries need surgery. Now we’ve done the research to show that’s not actually the case and our first reaction should probably be not to do surgery,” Dr. Nepple explained.
While surgery may still be needed in select cases, such as those involving significant cosmetic or functional concerns, the FACTS research shows the benefits of non-surgical treatment for pediatric clavicle fractures. By embracing this change in thinking, clinicians can optimize patient outcomes while minimizing unnecessary surgeries.
Claire's Case
Claire, then 12 years old, sustained a soccer injury and a visit to the emergency department confirmed she had a displaced clavicle fracture. Her mom shared, "We assumed that she would definitely need surgery and we were stressed by what that recovery would look like." Luckily, Claire was seen by Dr. Nepple who knew the benefit of allowing adolescent patients to recover without surgery. Claire is an extremely active kid and loves to play soccer, swim, bike, and most of all, run. However, proper healing required this active girl to sit on the sidelines briefly. “In some cases, particularly for non-contact sports, we can get adolescent athletes back as fast or even faster without surgery,” Dr. Nepple added.
Claire’s downtime allowed this young athlete to be introspective and appreciate what she was missing. She knew she wanted to get back to running as soon as she could. While she was in a sling for several weeks, Claire was so relieved to be cleared to resume her activities. Just four weeks after her injury, she ran a 15K and three months after the injury, she had already run a triathlon. Claire is a stronger runner than ever, setting many personal records since recovery!
Like all good surgeons, Dr. Nepple knows when surgery isn't the best option for his patients. Claire and her family were certainly glad her healing journey did not need to include surgery in order to get back to being a happy and active kiddo.
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