Evaluation and management of clavicle fractures in the juvenile population: a retrospective analysis of 456 patients

Background: Pediatric clavicle fractures in the juvenile population are common injuries that typically heal successfully with nonoperative treatment. Despite this favorable natural history, many centers continue to schedule routine outpatient follow-up visits and obtain repeated radiographs after the initial orthopedic consultation, although the true clinical value of these practices remains uncertain. Methods: We retrospectively reviewed 456 children aged 3–10 years who presented with clavicle fractures. Fracture location, displacement pattern, periosteal integrity, treatment modality, union status, and radiographic remodeling were recorded, along with demographic variables. The primary outcome measure was any change in clinical management following the initial orthopedic consultation. Patients with polytrauma, pathologic fractures, or those lost to follow-up were excluded; the analysis focused on isolated clavicle fractures in this age group. Results: The majority of fractures were located at the midshaft (93.0%). Nonoperative management predominated: Velpeau bandages were used in 63.2% of patients and figure-of-eight bandages in 36.4%. Surgical treatment was required in only two patients (0.4%), both due to an increased risk of skin compromise. Complete fracture union was observed in 453 of 456 patients (99.3%); two refractures subsequently achieved union, and one case demonstrated radiographic findings consistent with clavicular pseudoarthrosis. In asymptomatic patients, follow-up visits and repeat radiographs did not lead to any change in management, and no neurovascular complications were identified. Conclusions: In juvenile patients with isolated and uncomplicated clavicle fractures—including completely displaced patterns—routine clinical follow-up and serial radiographic evaluations after the initial assessment may be unnecessary. A selective follow-up strategy based on clinical findings could reduce radiation exposure and healthcare utilization without compromising patient outcomes.