Continuing Trend of Increased Operative Treatment of Clavicle Fractures in Pediatric Patients in the United States Despite a Lack of Supporting Evidence in the Literature.

Introduction

Pediatric clavicle fractures are among the most common fractures in this age group. Current research supports the efficacy of nonoperative treatment for these injuries in pediatric patients. Our study seeks to examine the current trends in the management of these fractures and determine whether they align with the existing evidence-based guidelines.

Methods

A retrospective analysis of pediatric patients with clavicle fractures between 1 January 2014 and 31 December 2024 was analyzed. A retrospective query was performed using the TriNetX Research Network. Patients were dichotomized into two groups based on open reduction internal fixation and nonoperative or closed treatment codes over this period, performing subgroup analyses by sex, race, and age.

Results

We evaluated 78,251 patients between 10 and 18 years with clavicle fractures from 2014 to 2024, of whom 3546 underwent open reduction and internal fixation (ORIF). ORIF utilization increased from 1.62% in 2014 to 5.89% in 2024, representing a 263.6% increase from the 2014 baseline. Males consistently underwent ORIF more often than females. Adolescents (15-18 years) had substantially higher and faster-rising ORIF rates than younger patients (10-14 years), increasing from 3.4% to 12.4% versus 0.8% to 2.5% between 2014 and 2024 (APC 7.5% vs. 0%, p = 0.001). White patients had higher ORIF rates than African American patients, although some disparities narrowed over time.

Conclusions

Despite limited supporting evidence, current trends demonstrate a substantial increase in the surgical management of pediatric clavicle fractures, with operative treatment rising by 263.6% by 2024. This increase in ORIF procedures may expose patients to potentially avoidable risks, including infection, anesthesia-related complications, implant-related issues, and prolonged recovery, without clearly established benefits in many cases.