Outcomes of Operatively Treated Non-unions and Symptomatic Mal-unions of Adolescent Diaphyseal Clavicle Fractures
Bibliographic record
Abstract
Objectives: The purpose of the study was to review the clinical characteristics and outcomes of adolescent diaphyseal clavicle fractures treated surgically for non-union, impending non-union, or symptomatic mal-union, which are rare complications of primary non-operative treatment. Methods: Records of all patients 10-18 years-old who underwent surgery at a tertiary-care children's hospital between 2003-2013 for a symptomatic mal-union, non-union (no bony bridging >6 mo post-fx), or impending non-union (no callus 1-6 mo post-fx) of a clavicle shaft fracture were reviewed. Demographic data, radiographic features, operative details, and post-operative course were analyzed and compared to an age-matched, sex-matched, and fracture pattern-matched control group of adolescents who underwent plate fixation as primary fracture treatment. Results: Sixteen patients (56% male; mean age 15.4 years, range 12.4-17.7 years) met inclusion/exclusion criteria, most of whom (87.5%) were initially treated at an outside hospital. Plate fixation, with or without osteotomy, was performed in 14 cases (87.5%), with bone grafting in 13 cases (81.3%), including iliac crest autograft (n=4), local bone graft (n=4), cancellous allograft (n=1), or local graft + cancellous allograft (n=4). Two mal-union cases (12.5%) underwent ostectomy only. Comparisons of mean time between injury and surgery, time to healing, duration between surgery and return to sports, and rate of removal of hardware (excluding the two ostectomy patients) are detailed in Table 1. Conclusion: Adolescents who underwent surgery for diaphyseal clavicle fracture non-union, impending non-union or symptomatic mal-union demonstrated bony healing and returned to sports within 2-4 months, with a comparable post-operative course and rate of subsequent hardware removal to patients treated with plate fixation for their primary clavicle fracture. To address the rare instance of slow, failed, or painful healing following non-operative management of diaphyseal clavicle fracture in adolescents, surgical treatment, which may be more technically challenging and often requires bone grafting, has clinical and radiographic results that are comparable to primary fracture fixation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".