Ten-year study tracks trends in pediatric clavicle fractures across the U.S.

Journal: JSES Reviews, Reports & Techniques

Title: Mechanisms and Trends of Pediatric Clavicular Fractures in the United States: A 10-Year Epidemiologic Analysis of National Injury Data

Authors: Charu Jain, MD candidate at the Icahn School of Medicine at Mount Sinai

Sheena Ranade, MD, Associate Professor of Orthopedics (Pediatric Orthopedic Surgery) at the Icahn School of Medicine at Mount Sinai

Bottom line: Clavicular fractures are common injuries among children, usually due to sports-related trauma or accidental falls. The purpose of this study was to assess the epidemiology of clavicular fractures among children in the United States between 2014 and 2023.

Why this study is unique: This study is the first of its kind to analyze 10 years of national emergency department data on pediatric clavicle fractures in the United States.

Why the study is important: Understanding how and where children sustain clavicular fractures helps guide injury prevention, especially in sports and at home. The rise in hospital admissions over the course of this study underscores a need to examine why these injuries may be getting more severe.

How the research was conducted: Data were extracted from the National Electronic Injury Surveillance System (NEISS), a publicly available database representing approximately 100 emergency departments in the United States. NEISS was queried for all shoulder fractures in patients 0-18 years old. These fractures were then filtered for clavicle fractures. Queries were restricted to fractures from January 1, 2014, to December 31, 2023.

Results: The findings show that while overall rates for pediatric clavicular fractures remained stable over the course of the study, there was a statistically significant increase in hospital admissions due to those injuries during that same period. This suggests an increase in severity of those injuries necessitating admission.

What this study means for doctors: The data suggest that pediatric clavicular fractures may be becoming more severe, which calls for better injury prevention and management strategies for doctors, parents, and patients. For physicians, this requires careful assessment and more intensive treatment or monitoring as needed. This study provides valuable insight into where pediatric clavicle fractures are treated-whether in emergency departments, outpatient clinics, or primary care-which can help guide resource allocation for health systems and improve care pathways for patients. Since many clavicle fractures in children heal well without surgery, understanding treatment settings can support better patient management, reduce unnecessary ED visits, and optimize follow-up care.

What this study means for patients: For patients and their parents, the findings emphasize that while many clavicular fractures may heal, some may require closer care or even hospitalization. The findings also emphasize the need for rigorous safety protocols during play and sports to reduce injury risk.

What the next steps are for this work: Next steps include using this data to investigate whether clavicular fracture cases presenting to the ED are more severe or more likely to require surgery compared to those seen in outpatient settings. We also aim to identify how many cases go untreated and explore whether specific injury patterns or treatment settings correlate with better long-term outcomes. This will help refine clinical decision-making and improve care strategies for pediatric clavicular fractures.

Quotes:

"Our review of recent national data on pediatric clavicle fractures demonstrates that among younger children, there has been an increase in bed-related falls causing clavicular fractures," says Dr. Ranade. "Just as there has been a strong emphasis on safe sleep for infants, this study shows that attention should be placed in safe sleeping environments for toddler aged children to prevent falls out of bed."

"Understanding common mechanisms like sports injuries and falls from beds can help guide targeted prevention strategies and parent education," says Ms. Jain. "I would like to thank the Mount Sinai Department of Orthopedics for their support, our co-authors for their contributions, and Dr. Ranade for her guidance and mentorship throughout this project."