{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:49:37Z","timestamp":1774957777394,"version":"3.50.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Although many uncomplicated pediatric fractures do not require routine long-term follow-up with an orthopedic surgeon, practitioners with limited experience dealing with pediatric fractures will often defer to a strategy of frequent clinical and radiographic follow-up. Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of clavicle fractures was performed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Three hundred forty patients (227 males, 113 females) with an average age of 8.1 years (range, 0.1\u201317.8) were included in the study. The mean number of clinic visits including initial consultation in the emergency department was 2.1 (1.3). The mean number of radiology department appointments was 1.8 (1.3), where patients received a mean number of 4.2 (3.0) radiographs. Complications were minimal: 2 refractures in our series and no known cases of nonunion. All patients achieved clinical and radiographic union and returned to sport after fracture healing.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Our series suggests that the decision to treat operatively is made at the initial assessment. If no surgical indications were present at the initial assessment by the primary care physician, then routine clinical or radiographic follow-up is unnecessary. Our pediatric clavicle fracture pathway will reduce patient radiation exposure and reduce costs incurred by the health care system and patients' families without jeopardizing patient outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000001269","type":"journal-article","created":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T21:42:01Z","timestamp":1505770921000},"page":"706-710","source":"Crossref","is-referenced-by-count":11,"title":["Do All Clavicle Fractures in Children Need To Be Managed by Orthopedic Surgeons?"],"prefix":"10.1097","volume":"34","author":[{"given":"John","family":"Adamich","sequence":"first","affiliation":[{"name":"Hospital for Sick Children; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Howard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Camp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"bib1-20231002","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1097\/PEC.0b013e3182716fea","article-title":"Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?","volume":"28","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"bib2-20231002","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1503\/cmaj.100119","article-title":"Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial","volume":"182","year":"2010","journal-title":"CMAJ"},{"key":"bib3-20231002","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1308\/003588402760452457","article-title":"Management of paediatric clavicle fractures\u2014is follow-up necessary? An audit of 346 cases","volume":"84","year":"2002","journal-title":"Ann R Coll Surg Engl"},{"key":"bib4-20231002","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.injury.2005.12.010","article-title":"The socio-economical impact of paediatric fracture clinic appointments","volume":"37","year":"2006","journal-title":"Injury"},{"key":"bib5-20231002","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/BPO.0b013e3182857d9e","article-title":"Shoulder motion, strength, and functional outcomes in children with established malunion of the clavicle","volume":"33","year":"2013","journal-title":"J Pediatr Orthop"},{"issue":"suppl 1","key":"bib6-20231002","first-page":"S1","article-title":"Clavicle shaft fractures: are children little adults?","volume":"32","year":"2012","journal-title":"J Pediatr Orthop"},{"issue":"suppl 2","key":"bib8-20231002","first-page":"S69","article-title":"Pediatric clavicle and acromioclavicular injuries","volume":"30","year":"2010","journal-title":"J Pediatr Orthop"},{"key":"bib9-20231002","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/BPO.0b013e3181ff67ce","article-title":"A survey of physician opinion: adolescent midshaft clavicle fracture treatment preferences among POSNA members","volume":"31","year":"2011","journal-title":"J Pediatr Orthop"},{"key":"bib10-20231002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2106\/JBJS.F.00020","article-title":"Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial","volume":"89","year":"2007","journal-title":"J Bone Joint Surg Am"},{"key":"bib11-20231002","first-page":"35","article-title":"Deficits following nonoperative treatment of displaced midshaft clavicular fractures","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"bib12-20231002","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1302\/0301-620X.79B4.0790537","article-title":"Closed treatment of displaced middle-third fractures of the clavicle gives poor results","volume":"79","year":"1997","journal-title":"J Bone Joint Surg Br"},{"key":"bib13-20231002","first-page":"736","article-title":"Operative treatment of clavicle fractures in children: a review of 21 years","year":"2002","journal-title":"J Pediatr Orthop"},{"key":"bib14-20231002","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1097\/BPO.0b013e3181c29c9c","article-title":"Operative treatment of completely displaced clavicle shaft fractures in children","volume":"29","year":"2009","journal-title":"J Pediatr Orthop"},{"key":"bib15-20231002","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/BPO.0b013e3181db3227","article-title":"Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents","volume":"30","year":"2010","journal-title":"J Pediatr Orthop"},{"key":"bib16-20231002","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.2106\/JBJS.L.01390","article-title":"Functional and radiographic outcomes of adolescent clavicle fractures","volume":"95","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"bib17-20231002","doi-asserted-by":"crossref","first-page":"498","DOI":"10.5435\/JAAOS-20-08-498","article-title":"Displaced clavicle fractures in adolescents: facts, controversies, and current trends","volume":"20","year":"2012","journal-title":"J Am Acad Orthop Surg"},{"key":"bib18-20231002","doi-asserted-by":"crossref","first-page":"199","DOI":"10.5435\/JAAOS-21-04-199","article-title":"Displaced clavicle fractures in adolescents: facts, controversies, and current trends","volume":"21","year":"2013","journal-title":"J Am Acad Orthop Surg"},{"key":"bib19-20231002","first-page":"1","article-title":"Displaced clavicle fractures in adolescents: facts, controversies, and current trends","volume":"21","year":"2013","journal-title":"J Am Acad Orthop Surg"},{"key":"bib20-20231002","first-page":"1","volume":"21","year":"2013","journal-title":"Correspondence Displaced Clavicle Fractures in Adolescents: Facts, Controversies"},{"key":"bib21-20231002","doi-asserted-by":"crossref","first-page":"542","DOI":"10.2106\/JBJS.I.00450","article-title":"Epidemiology of shoulder dislocations presenting to emergency departments in the United States","volume":"92","year":"2010","journal-title":"J Bone Jt Surg Am"},{"key":"bib22-20231002","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.2106\/JBJS.K.01275","article-title":"Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle","volume":"95","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"bib24-20231002","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jpeds.2008.08.013","article-title":"Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills","volume":"154","year":"2009","journal-title":"J Pediatr"},{"key":"bib25-20231002","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0020-1383(99)00248-X","article-title":"The cost of treatment of distal radial fractures","volume":"31","year":"2000","journal-title":"Injury"},{"issue":"suppl 2","key":"bib26-20231002","first-page":"121","article-title":"Cancer risks following diagnostic and therapeutic radiation exposure in children","volume":"36","year":"2006","journal-title":"Pediatr Radiol"},{"key":"bib27-20231002","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/j.1553-2712.2010.00788.x","article-title":"Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department","volume":"17","year":"2010","journal-title":"Acad Emerg Med"},{"key":"bib28-20231002","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1067\/mse.2003.25","article-title":"Optimizing the radiographic technique in clavicular fractures","volume":"12","year":"2003","journal-title":"J Shoulder Elbow Surg"},{"key":"bib29-20231002","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/BOT.0b013e318178d97d","article-title":"Length determination in midshaft clavicle fractures: validation of measurement","volume":"22","year":"2008","journal-title":"J Orthop Trauma"},{"key":"bib30-20231002","first-page":"68","article-title":"Distal clavicular physeal injury","volume":"188","year":"1984","journal-title":"Clin Orthop Relat Res"},{"key":"bib31-20231002","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.injury.2015.04.019","article-title":"Sports participation and radiographic findings of adolescents treated nonoperatively for displaced clavicle fractures","volume":"46","year":"2015","journal-title":"Injury"},{"key":"bib32-20231002","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2106\/JBJS.G.00682","article-title":"The American Orthopaedic Association's \"own the bone\" initiative to prevent secondary fractures","volume":"90","year":"2008","journal-title":"J Bone Joint Surg Am"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00006565-201810000-00006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T21:09:39Z","timestamp":1696280979000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00006565-201810000-00006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":30,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000001269","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}