The aim of this study was to define the long-term outcome following adolescent clavicle fracture. We retrospectively reviewed all adolescent fractures presenting to our region (13–17years) over a 10-year period. Patient reported outcomes were undertaken at a minimum of 4 years post-injury (QuickDASH and EQ-5D) in completely displaced midshaft fractures (Edinburgh 2B, >2cm displacement, n=50) and angulated midshaft fractures (Edinburgh 2A2, >30 degrees angulation, n=32). 677 clavicle fractures were analysed. The median age was 14.8 (IQR 14.0–15.7) and 89% were male. The majority were midshaft (n=606, 89.5%) with either angulation (39.8%) or simple fully displaced (39.1%). Only 3% of midshaft fractures underwent acute fixation (n=18/606), all of which were fully displaced. The incidence of refracture following non-operative management of midshaft fractures was 3.2% (n=19/588), all united with non-operative management. Fracture type, severity of angulation or displacement was not associated with risk of refracture. There was one case of non-union encountered following non-operative management of all displaced midshaft fractures (0.4%, n=1/245). At a mean of 7.6 years following injury, non-operative management of both displaced and angulated fractures had a median QuickDASH was 0.0 (IQR 0.0–2.3), EQ-5D was 1.0 (IQR 1.0–1.0). 97% of angulated fractures and 94% of displaced fractures were satisfied with their final shoulder function. We conclude that Non-operative management of adolescent midshaft clavicle fractures result in excellent functional outcomes with a low rate of complications at long-term follow up. The relative indications for surgical intervention for clavicle fractures in adults do not appear to be applicable to adolescents.
Polyethylene (PE) wear affects survivorship in the long term while dislocation remains a significant factor in the short term. Increasing head size can reduce impingement and dislocation. However, this increases wear rates and reduces the net thickness of the liner. Several reports have demonstrated significant reduction in wear in cross-linked PE. This study reports wear rates in crosslinked PE liners with increased head size. Four groups of PE liners were tested against cobalt-chrome heads in a hip wear simulator: highly crosslinked liners with head size 28mm (28XPE) and 32mm (32XPE), and minimally crosslinked liners with head size 28mm (28PE) and 32mm (32PE). Additional liners were used as load-soak controls to monitor weight gain due to fluid absorption. Gravimetric analysis was performed every 500,000 cycles for a total of 5,000,000 cycles. 28PE and 32PE liners had mean wear rates of 12.5(±1.0) and 17.45 (±2.6) mg/million cycles. Both highly crosslinked PE liners (28XPE and 32XPE) had significant less wear rates that regular polyethylene 1.49 (±0.72) and 2.55 (±0.19) mg/million cycles respectively. Increasing head size resulted in increased wear, which is consistent with previous reports. Highly crosslinked PE significantly reduced wear rates in both head sizes. Although there was a small increase in wear in the 32XPE group compared to the 28XPE group, wear was significantly less than both 32PE and 28PE groups. These encouraging results suggest that a dual benefit (reduced wear and reduced dislocation rate) might be achieved using 32XPE liners. Further studies that evaluate fatigue damage, crack propagation and impingement are necessary.
