Objective:

To describe recovery after adjunctive focused electrohydraulic extracorporeal shockwave therapy in an adolescent with a displaced medial clavicle fracture.

Approach:

• Case: A 14-year-old female soccer player with a displaced right medial clavicle fracture was managed nonoperatively and began shockwave therapy on Day 4.
• Treatment and assessment: She received 18 sessions through Day 57. Researchers assessed pain, shoulder function, radiographic healing, return-to-sport readiness, and complications, with follow-up to about 1 year.

Key Findings:

• Pain and shoulder movement improved during treatment; early callus was visible on Day 15.
• Day 59 radiographs showed robust callus formation and fracture consolidation. With a stable fracture, full shoulder function, and no pain, she was cleared for unrestricted sports participation at about 8 weeks.
• A Day 50 radiograph showed mild apparent separation after she resumed carrying a heavy backpack; loading or imaging differences were considered possible explanations.
• At about 1 year, she remained asymptomatic, with no reported adverse events or further treatment. Radiographic healing was not reassessed at that visit.

Interpretation:

Recovery was earlier than the anticipated 12 weeks and the 103-day mean return-to-play interval cited from a systematic review, but differences between populations and fracture characteristics limit comparison. The case does not establish that shockwave therapy accelerated healing.

Limitations:

• Single-patient report with no comparison group; natural healing in children may have influenced recovery.
• No standardized pain or functional assessments, and radiographs were not independently reviewed by blinded assessors.
• The treatment protocol was selected empirically, and historical recovery estimates came from heterogeneous fracture populations.

Conclusion:

The authors described the findings as hypothesis-generating and called for prospective studies to define the treatment’s role, safety, and efficacy in pediatric populations.

Sources:

• Case Reports in Orthopedics