{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:32:06Z","timestamp":1777390326873,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative outcomes of comminuted and\/or severely shortened clavicular fractures specifically in older adolescent athletes have not been explored in a focused, methodologically rigorous fashion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>The study hypothesis was that outcomes would be superior in older adolescent athletes who underwent operative treatment compared with nonoperative treatment for comminuted and\/or severely shortened clavicular fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A level 2, multicenter, prospective cohort study investigating the outcomes of midshaft fractures in adolescents between 2013 and 2017 was filtered to analyze the subcohorts of athletes 14 to 18 years of age with either fracture comminution or fracture shortening of \u226525 mm or both. Patient characteristics, injury mechanisms, fracture characteristics, and treatments were compared. Complications, rates, timing of return to sports (RTS), and patient-reported outcomes (PROs) were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The 2 treatment groups, which included 136 older adolescent athletes (69 nonoperative, 67 operative), showed similar distributions of primary sport type, competition level, comminution, shortening, and 2-year PRO response rate (n = 99; 73%). The operative group demonstrated 3 mm\u2013greater mean superior displacement, which was therefore statistically controlled for as a confounder in the comparative PRO analysis. No 2-year differences in nonunion, delayed union, symptomatic malunion, refracture, clinically significant complications, or rates of RTS were detected between treatment groups. The difference in timing of RTS (operative, 10.3 weeks; nonoperative, 13.5 weeks) was statistically significant. After controlling for the minor difference in superior displacement, regression analysis and matched comparison cohorts demonstrated no differences between the nonoperative and operative groups in mean or dichotomized PRO scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In this prospective, multicenter cohort study investigating older adolescent athletes with comminuted and\/or severely shortened clavicular fractures, contrary to the study hypothesis, there were no differences in complications, RTS, or PROs between nonoperatively and operatively treated patients at 2 years. Comparably excellent outcomes of severe clavicular fractures in adolescent athletes can be achieved with nonoperative treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465231219248","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T23:56:31Z","timestamp":1705622191000},"page":"423-430","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Treatment of Severely Shortened or Comminuted Clavicular Fractures in Older Adolescent Athletes"],"prefix":"10.1177","volume":"52","author":[{"given":"David D.","family":"Spence","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center \u2013 Campbell Clinic, Memphis, Tennessee, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip L.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Sports Medicine Center, Texas Scottish Rite Hospital, Dallas, Texas, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8628-5603","authenticated-orcid":false,"given":"Andrew T.","family":"Pennock","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Rady Children's Hospital, San Diego, California, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey J.","family":"Nepple","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirav K.","family":"Pandya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crystal A.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry B.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Sports Medicine Center, Texas Scottish Rite Hospital, Dallas, Texas, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Coleen S.","family":"Sabatini","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric W.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Rady Children's Hospital, San Diego, California, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Clifton","family":"Willimon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald S.","family":"Bae","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael T.","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mininder","family":"Kocher","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"FACTS Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2572-1344","authenticated-orcid":false,"given":"Benton E.","family":"Heyworth","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA)"},{"name":"Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"bibr1-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000000986"},{"key":"bibr2-03635465231219248","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00020"},{"issue":"10","key":"bibr3-03635465231219248","first-page":"1119","volume":"145","author":"DuRant RH","year":"1991","journal-title":"Am J Dis Child"},{"key":"bibr4-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120921344"},{"key":"bibr5-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221114420"},{"key":"bibr6-03635465231219248","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.01284"},{"key":"bibr7-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000877"},{"key":"bibr8-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-5204-6"},{"issue":"10","key":"bibr9-03635465231219248","volume":"21","author":"Marsh JL","year":"2007","journal-title":"J Orthop Trauma"},{"key":"bibr10-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2015.11.065"},{"key":"bibr11-03635465231219248","doi-asserted-by":"publisher","DOI":"10.3171\/2012.1.SPINE11842"},{"key":"bibr12-03635465231219248","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2013.867782"},{"key":"bibr13-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2017.06.040"},{"key":"bibr14-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-5-70"},{"key":"bibr15-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514559913"},{"key":"bibr16-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.80B3.0800476"},{"key":"bibr17-03635465231219248","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00307"},{"key":"bibr18-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516673615"},{"key":"bibr19-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1016\/j.jht.2015.09.003"},{"key":"bibr20-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0000000000000301"},{"key":"bibr21-03635465231219248","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.01296"},{"key":"bibr22-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-004-7713-0"},{"key":"bibr23-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-4968-z"},{"key":"bibr24-03635465231219248","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000258"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465231219248","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03635465231219248","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465231219248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:50:13Z","timestamp":1777369813000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03635465231219248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1177\/03635465231219248"],"URL":"https:\/\/doi.org\/10.1177\/03635465231219248","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,18]]}}}