{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:42:40Z","timestamp":1781930560096,"version":"3.54.5"},"reference-count":44,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"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":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Optimal treatment of completely displaced midshaft clavicular fractures in adolescents remains controversial, with some favoring surgical management and others favoring a nonoperative approach. Few studies have comprehensively assessed longer-term nonoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To prospectively assess patient-reported outcomes (PROs) and radiographic remodeling \u22655 years after injury in teenagers undergoing nonoperative treatment of completely displaced clavicular fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Case series; Level of evidence, 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Adolescent patients previously enrolled in a prospective study from a single institution with nonoperatively treated, completely displaced midshaft clavicular fractures \u22655 years from injury were eligible for the study. Patients were clinically evaluated for scapular dyskinesia and strength deficits. Bilateral clavicular imaging assessed residual shortening, displacement, and angulation. PROs included the American Shoulder and Elbow Surgeons (ASES), the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Marx Shoulder Activity Scale, cosmesis, and return to sports data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 24 patients were available for the follow-up, of whom 17 (71%) consented to additional imaging. The mean cohort age at the time of injury was 14.5 \u00b1 1.1 years, with 88% being male. At a mean follow-up of 6.1 years, all fractures had healed, with no patient requiring secondary interventions. Significant remodeling was observed across all measurements, with improvements of 70% in shortening (22.8 to 6.8 mm;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001), 73% in superior displacement (13.4 to 3.6 mm;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001), and 83% in angulation (10.4\u00b0 to 1.8\u00b0;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Thirteen patients (72%) had a &gt;2-cm initial shortening, and all remodeled to &lt;2 cm. PROs were almost universally excellent, with mean ASES, QuickDASH, and Marx activity scores of 99 \u00b1 3, 1 \u00b1 3, and 20 \u00b1 1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Most patients (58%) were completely satisfied with their shoulder appearance, 38% were more satisfied than not, 1 patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 who were interested in sports returned to sporting activities. PROs were not associated with bony remodeling (\n                      <jats:italic>P<\/jats:italic>\n                      &gt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Teenaged patients with completely displaced clavicular fractures treated nonoperatively can expect excellent radiographic and clinical outcomes 5 years after injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465241228818","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T02:09:40Z","timestamp":1709604580000},"page":"1032-1039","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["5-Year Radiographic and Functional Outcomes of Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers"],"prefix":"10.1177","volume":"52","author":[{"given":"Samuel G.","family":"Polinsky","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA; University of California, San Diego, San Diego, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5724-5645","authenticated-orcid":false,"given":"Eric W.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA; University of California, San Diego, San Diego, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey P.","family":"Bastrom","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1925-4081","authenticated-orcid":false,"given":"Claire E.","family":"Manhard","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2572-1344","authenticated-orcid":false,"given":"Benton E.","family":"Heyworth","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"FACTS Study Group:","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald S.","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Busch","sequence":"additional","affiliation":[{"name":"Children\u2019s Healthcare of Atlanta, Atlanta, Georgia, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry B.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Texas Scottish Rite Hospital for Children, Dallas, Texas, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn","family":"Hergott","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7938-7820","authenticated-orcid":false,"given":"Mininder S.","family":"Kocher","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[{"name":"C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Nepple","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirav K.","family":"Pandya","sequence":"additional","affiliation":[{"name":"UCSF Benioff Children\u2019s Hospital, Oakland, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal","family":"Perkins","sequence":"additional","affiliation":[{"name":"Children\u2019s Healthcare of Atlanta, Atlanta, Georgia, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coleen S.","family":"Sabatini","sequence":"additional","affiliation":[{"name":"UCSF Benioff Children\u2019s Hospital, Oakland, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"Spence","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Campbell Clinic, Memphis, Tennessee, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel C.","family":"Willimon","sequence":"additional","affiliation":[{"name":"Children\u2019s Healthcare of Atlanta, Atlanta, Georgia, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip L.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Texas Scottish Rite Hospital for Children, Dallas, Texas, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8628-5603","authenticated-orcid":false,"given":"Andrew T.","family":"Pennock","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA; University of California, San Diego, San Diego, California, USA"},{"name":"Investigation performed at Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3182857d9e"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e31825870ad"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00020"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181ff67ce"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120921344"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00449938"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3182518a15"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20150204-62"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221114420"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.79B4.0790537"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11420-020-09754-8"},{"key":"e_1_3_2_13_2","first-page":"1","article-title":"Fracture patterns in children. 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