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The Clavicle Continues to Grow During Adolescence and Early Adulthood

  • Original Article
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HSS Journal ®

Abstract

Background

As more adults undergo surgical fixation of clavicle fractures with improved outcomes, interest is renewed in managing clavicle fractures in adolescents. The medial clavicular physis does not fuse until 23 to 25 years of age, but studies report minimal clavicular growth during adolescence—studies that employed cross-sectional methodologies, which cannot not capture growth in patients over time. The assumption that clavicle length at each stage is uniform, as is the final overall length, may not be accurate if the age groups studied comprise various ethnicities, socioeconomic status, or height.

Questions/Purposes

We sought to quantify longitudinal clavicular growth on serial radiographs in adolescents and young adults. Our hypothesis was that substantial clavicular growth would be seen beyond the age of 12 years.

Methods

We conducted a longitudinal case series of non-syndromic patients in a single orthopedic clinic and analyzed serial radiographic images of the clavicles. For ethical reasons, only patients with non-neuromuscular scoliosis and kyphosis (in whom the existing standard of care includes serial thoracic radiographs) were considered for inclusion. Patients ages 10 to 25 years old were included in the study if three or more serial thoracic radiographs over a minimum 5 years were available that captured the entire length of at least one non-rotated clavicle. Three types of radiographs were included for analysis: digital low-dose-radiation stereoradiographic (EOS Imaging, Paris, France), non-EOS digital, and non-EOS printed. The overall longitudinal growth, yearly growth, and the yearly growth percentage were calculated for each clavicle.

Results

Fifty-seven patients (22 male and 35 female) met the inclusion criteria. In male patients, at ages 12 to 15 years, the clavicular growth was 4.9 mm/year, or 4%/year; at ages 16 to 19 years, growth was 3.2 mm/year, or 2.4%/year; and at ages 20 to 25 years, growth was 1.7 mm/year, or 1.1%/year. In female patients, at ages 12 to 15 years, growth was 4.7 mm/year, or 4%/year; at 16 to 19 years, growth was 2.2 mm/year, or 1.7%/year; and at ages 20 to 25 years, growth was 0.2 mm/year or 0.1%/year. We could not detect the age of terminal growth in either sex because growth was ongoing in most patients in the oldest group.

Conclusion

We found substantial clavicular growth potential after age 18 years, when growth is thought to be nearly finished, as well as remodeling potential even up to age 25 years. Further research is needed, but our findings suggest that strategies for managing clavicle fracture in adults may not be applied universally to adolescents and young adults.

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Funding

This study was supported by Rady Children’s Hospital, San Diego, Division of Orthopedics.

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Authors and Affiliations

  1. Baylor Scott & White Medical Center, Temple, TX, USA

    Jessica L. Hughes MD

  2. Rady Children’s Hospital–San Diego, MD 3020 Children’s Way, MC 5062, San Diego, CA, 92123, USA

    Peter O. Newton MD, Tracey Bastrom MS & Andrew T. Pennock MD

  3. University of California San Diego, San Diego, CA, USA

    Peter O. Newton MD & Andrew T. Pennock MD

  4. Hospital for Special Surgery, New York, NY, USA

    Peter D. Fabricant MD, MPH

Authors
  1. Jessica L. Hughes MD
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  2. Peter O. Newton MD
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  3. Tracey Bastrom MS
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  4. Peter D. Fabricant MD, MPH
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  5. Andrew T. Pennock MD
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Corresponding author

Correspondence to Andrew T. Pennock MD.

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Conflict of Interest

Tracey Bastrom, MS, declares no conflicts of interest. Jessica L. Hughes, MD, reports personal fees or other material support from Depuy Synthes, Medical Device Business Services, Axogen, Stryker, Globus Medical, and Sanofi-Aventis, outside the submitted work. Peter O. Newton, MD, reports personal fees or other material support from Nuvasive, Zimmer Biomet, K2M, Medtronic USA, Merck Sharp & Dohme Corp., Globus Medical, Ethicon, and Depuy Synthes, outside the submitted work. Peter D. Fabricant, MD, MPH, reports personal fees or other material or nonfinancial support from Smith & Nephew, Medical Device Business Services, and Arthrex, and personal fees and board membership from Clinical Orthopedics and Related Research, Pediatric Orthopedic Society of North America, Pediatric Research in Sports Medicine Society, and Research in OsteoChondritis of the Knee (ROCK), outside the submitted work. Andrew T. Pennock, MD, reports personal fees or other material support from Stryker, Sportstek Medical, Orthopediatrics, Smith & Nephew; personal fees and board membership from American Orthopedic Society for Sports Medicine and Pediatric Orthopedic Society of North America; and stock or stock options from Imagen, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was obtained from all patients for being included in this study.

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Level of Evidence: Level IV: Retrospective case series

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Hughes, J.L., Newton, P.O., Bastrom, T. et al. The Clavicle Continues to Grow During Adolescence and Early Adulthood. HSS Jrnl 16 (Suppl 2), 372–377 (2020). https://doi.org/10.1007/s11420-020-09754-8

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  • DOI: https://doi.org/10.1007/s11420-020-09754-8

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