Yes or no? Is surgery needed for a clear break (and separation) of the collar-bone in a 13-year-old boy? He’s eager to get back to skate boarding and BMX racing. Surgery would really hold him back. What do you think?

There is a recent study from Rady Children’s Hospital in San Diego, California that may be the first to report detailed results of conservative (nonoperative) care of midshaft clavicular factures in adolescents.

There were sixteen adolescents enrolled in the study in a 4:1 ratio of males to females (i.e., 12 males and 4 females). The majority of teens (13 of the 16) broke the clavicle on the nondominant side.

Treatment was with the arm on the affected side in a sling until X-rays showed healing had occurred. Measurements were taken before and after treatment of shoulder motion, length of the clavicle (fractured bone compared to the other side), and strength (isometric muscle testing). Each of these measurements was compared to the normal side.

There were very few differences after treatment between the fractured side and the uninvolved arm. Slight differences were noted in external rotation strength and abduction endurance. Despite changes in the length of the clavicle (longer or shorter) on the fractured side, there was a 100 per cent rate of union (healing of the two fractured ends of the clavicle).

Only one of the 16 patients was unhappy with the results and that was because that particular person still had shoulder pain. And everyone returned to their full activity level, even those who were involved in sports.

The results of this study support Mercer Rang’s axiom, If the two ends of the clavicle are in the same room, they will heal. Reliable healing with few long-term symptoms is possible and even probable because the bone will remodel successfully in this age group.

There is a minimal loss of strength due to biomechanical changes in clavicular length. This has the potential to put stress on the joints of the shoulder and decrease the force generated by the muscles for strength. Even so, these teens were still able to function fully in all daily and sports activities.

The authors of this particular study suggest if surgery can be avoided with conservative care only, it may be possible to eliminate complications such as numbness from the incision and/or infection. Likewise, with conservative care, there is no need for fixation with metal plates or other hardware that may need to be removed later in a second surgery.

This study confirmed that the nonoperative approach can be successful with midshaft clavicle fractures in teens. If there are any reasons why surgery is recommended for your son, the surgeon will outline these for you. A decision can be reached based on all factors present.