title: Pediatric refracture rates after angulated and completely displaced clavicle shaft fractures.
abstract: OBJECTIVE
  The purpose of this study was to assess refracture rates after angulation-only and completely displaced clavicle shaft fractures in children.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Level 1 pediatric trauma center.
  
  
  METHODS
  Computerized medical records searches identified children treated nonoperatively for clavicle shaft fractures at our institution. Inclusion criteria were age less than 18 years and a minimum of 1-year radiographic follow-up. Statistical methods included Fisher exact test with significant probability values being defined as less than 0.05.
  
  
  RESULTS
  Of the 120 angulation-only patients and 41 completely displaced patients meeting criteria for inclusion in our study, we identified a statistically higher (P = 0.002) refracture rate (18%, 21/120) in angulation-only fractures as compared with 0% (0/41) for completely displaced fractures. Subgroup analysis of the angulation-only fractures revealed that fractures angulated less than 40 degrees refractured at a 26% rate (18/69) versus 6% (3/51) of fractures with greater angulation (P = 0.004).
  
  
  CONCLUSIONS
  We found that angulation-only shaft fractures had a significantly higher refracture rate than completely displaced fractures. Furthermore, subgroup analysis demonstrated that less-angulated fractures had a higher refracture rate than the more-angulated ones. We feel this somewhat paradoxical finding is analogous to fractures of the forearm shaft, for which greenstick fractures refracture at a higher rate than complete forearm shaft fractures due to less-exuberant callus formation.
  
  
  METHODS
  Prognostic level III. See instructions for authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Masnovi
authors.forename: Charles T
authors.initials: CT
authors.lastname: Mehlman
authors.forename: Emily A
authors.initials: EA
authors.lastname: Eismann
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Matey
mesh_terms: D002648:Child; D002675:Child, Preschool; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure