{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:36:49Z","timestamp":1787755009518,"version":"build-2784847793"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Although multiple prospective comparative studies exist for adults with midshaft clavicle fractures, few comparative studies exist in older children and adolescents. This study compares intermediate-term functional, pain, radiographic, and complication outcomes in children and adolescents with midshaft clavicle fractures treated operatively or nonoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Children and adolescents who were 10 to 18 years of age with midshaft clavicle fractures treated from 2006 to 2017 were identified through electronic picture archiving and communication system (PACS) radiographic and chart review. Closed injuries with a minimum of 1 year from the time of the injury were included. Patients completed patient-reported outcome measures and a focused questionnaire. The primary outcome was the abbreviated Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) score; the secondary outcomes included the University of California Los Angeles (UCLA) Activity Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and PROMIS Physical Function (PF) Upper Extremity (UE), Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Numeric Rating Scale (NRS) for Pain, and rates of implant removal, nonunion, and refracture. Univariate comparisons between the operatively treated group and the nonoperatively treated group were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In this study, 302 patients were identified; of these, 79 patients (43 operatively treated and 36 nonoperatively treated) or their parent or legal guardian consented and the patients completed the study protocol. The mean age (and standard deviation) at the time of the injury was 16.0 \u00b1 1.7 years for the operatively treated group and 13.5 \u00b1 1.8 years for the nonoperatively treated group (p &lt; 0.001). The median follow-up was 3.8 years. The patient-reported outcome scores were similar (p &gt; 0.05 for all comparisons) between the operatively treated group and the nonoperatively treated group, even for patients at or near skeletal maturity and those with shortening of \u226515 mm or \u2265100% translation. There were no nonunions. The refracture rate was 5% (2 of 43) for the operatively treated group and 3% (1 of 36) for the nonoperatively treated group (p = 1.00). There were 19% (8 of 43) who underwent implant removal. Responders were similar to nonresponders, other than female patients (p &lt; 0.001) and surgically treated patients (p = 0.049) being more likely to respond.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In the subset of this cohort who responded and completed the study, both operatively and nonoperatively treated patients had excellent functional and pain outcomes, similar refracture rates, and no nonunions. Even in widely displaced and translated fractures, and in those at or near skeletal maturity, outcomes were similar. Operative management should potentially be reserved for special circumstances. A prospective comparative study of older adolescents (female patients who are 14 to 18 years of age and male patients who are 16 to 20 years of age) with displaced midshaft clavicle fractures is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.20.00036","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T15:00:07Z","timestamp":1611068407000},"page":"e20.00036-e20.00036","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Intermediate-Term Outcomes Following Operative and Nonoperative Management of Midshaft Clavicle Fractures in Children and Adolescents"],"prefix":"10.2106","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3481-3408","authenticated-orcid":false,"given":"Ishaan","family":"Swarup","sequence":"first","affiliation":[{"name":"UCSF Benioff Children\u2019s Hospital Oakland, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4685-6563","authenticated-orcid":false,"given":"Bhargavi","family":"Maheshwer","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5645-6168","authenticated-orcid":false,"given":"Steven","family":"Orr","sequence":"additional","affiliation":[{"name":"NYU Langone Orthopedic Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1731-8010","authenticated-orcid":false,"given":"Clare","family":"Kehoe","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3604-8615","authenticated-orcid":false,"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-4341","authenticated-orcid":false,"given":"Emily","family":"Dodwell","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"},{"name":"New York Presbyterian\u2013Weill Cornell Medical Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1]]},"reference":[{"issue":"4","key":"R1-20240801","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/BPO.0000000000000082","article-title":"Long-term patient-reported outcome after fractures of the clavicle in patients aged 10 to 18 years","volume":"34","author":"Randsborg","year":"2014","journal-title":"J Pediatr Orthop"},{"key":"R2-20240801","first-page":"1","article-title":"Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979","volume":"202","author":"Landin","year":"1983","journal-title":"Acta Orthop Scand Suppl"},{"key":"R3-20240801","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00003086-199403000-00016","article-title":"The incidence of fractures of the clavicle","volume":"300","author":"Nordqvist","year":"1994","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"R4-20240801","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s004020000202","article-title":"Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion","volume":"121","author":"Wick","year":"2001","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"R5-20240801","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2106\/JBJS.F.00020","article-title":"Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial","volume":"89","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"R6-20240801","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/BPO.0b013e3181ff67ce","article-title":"A survey of physician opinion: adolescent midshaft clavicle fracture treatment preferences among POSNA members","volume":"31","author":"Carry","year":"2011","journal-title":"J Pediatr Orthop"},{"issue":"11","key":"R7-20240801","doi-asserted-by":"crossref","first-page":"e439","DOI":"10.1097\/BOT.0000000000001580","article-title":"Operative versus nonoperative management of displaced midshaft clavicle fractures in pediatric and adolescent patients: a systematic review and meta-analysis","volume":"33","author":"Gao","year":"2019","journal-title":"J Orthop Trauma"},{"issue":"1","key":"R8-20240801","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s12178-020-09604-4","article-title":"Operative versus non-operative management of mid-diaphyseal clavicle fractures in the skeletally immature population: a systematic review and meta-analysis","volume":"13","author":"Nawar","year":"2020","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"4","key":"R9-20240801","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/BPO.0b013e3181db3227","article-title":"Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents","volume":"30","author":"Vander Have","year":"2010","journal-title":"J Pediatr Orthop"},{"issue":"2","key":"R10-20240801","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.3928\/01477447-20150204-62","article-title":"Outcomes of operative versus nonoperative treatment of displaced pediatric clavicle fractures","volume":"38","author":"Hagstrom","year":"2015","journal-title":"Orthopedics"},{"issue":"4","key":"R11-20240801","doi-asserted-by":"crossref","first-page":"e287","DOI":"10.3928\/01477447-20150402-56","article-title":"Complications in the treatment of adolescent clavicle fractures","volume":"38","author":"Luo","year":"2015","journal-title":"Orthopedics"},{"issue":"4","key":"R12-20240801","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1302\/1863-2548.11.160267","article-title":"Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents","volume":"11","author":"Herzog","year":"2017","journal-title":"J Child Orthop"},{"issue":"2","key":"R13-20240801","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1302\/1863-2548.12.170185","article-title":"Flexible intramedullary nailing versus nonoperative treatment for paediatric displaced midshaft clavicle fractures","volume":"12","author":"Mukhtar","year":"2018","journal-title":"J Child Orthop"},{"issue":"1","key":"R14-20240801","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/BPB.0000000000000535","article-title":"Nonoperative versus operative treatment for displaced midshaft clavicle fractures in adolescents: a comparative study","volume":"28","author":"Song","year":"2019","journal-title":"J Pediatr Orthop B"},{"issue":"4","key":"R15-20240801","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/BPO.0000000000000627","article-title":"Is there a deficit after nonoperative versus operative treatment of shortened midshaft clavicular fractures in adolescents?","volume":"37","author":"Parry","year":"2017","journal-title":"J Pediatr Orthop"},{"issue":"7","key":"R16-20240801","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/BPO.0000000000000832","article-title":"Complications after plate fixation of displaced pediatric midshaft clavicle fractures","volume":"38","author":"Li","year":"2018","journal-title":"J Pediatr Orthop"},{"issue":"7","key":"R17-20240801","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.injury.2015.04.019","article-title":"Sports participation and radiographic findings of adolescents treated nonoperatively for displaced clavicle fractures","volume":"46","author":"Robinson","year":"2015","journal-title":"Injury"},{"issue":"5","key":"R18-20240801","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/BPO.0b013e318220ba48","article-title":"Fixation of displaced midshaft clavicle fractures in skeletally immature patients","volume":"31","author":"Namdari","year":"2011","journal-title":"J Pediatr Orthop"},{"issue":"4","key":"R19-20240801","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/BPO.0b013e31825611da","article-title":"Operative treatment of adolescent clavicle fractures with an intramedullary clavicle pin","volume":"32","author":"Frye","year":"2012","journal-title":"J Pediatr Orthop"},{"issue":"6","key":"R20-20240801","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/BPO.0b013e31829d1a76","article-title":"Elastic stable intramedullary nailing for displaced pediatric clavicle midshaft fractures: a prospective study of the results and patient satisfaction in 24 children and adolescents aged 10 to 15 years","volume":"33","author":"Rapp","year":"2013","journal-title":"J Pediatr Orthop"},{"issue":"13","key":"R21-20240801","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.2106\/JBJS.L.01390","article-title":"Functional and radiographic outcomes of nonoperative treatment of displaced adolescent clavicle fractures","volume":"95","author":"Schulz","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"R22-20240801","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/BOT.0000000000000877","article-title":"Function After Adolescent Clavicle Trauma and Surgery (FACTS) Multicenter Study Group. Reliability of radiographic assessments of adolescent midshaft clavicle fractures by the FACTS Multicenter Study Group","volume":"31","author":"Li","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"5","key":"R23-20240801","first-page":"1038","article-title":"Development of the QuickDASH: comparison of three item-reduction approaches","volume":"87","author":"Beaton","year":"2005","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R24-20240801","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1177\/1753193413481302","article-title":"The DASH and the QuickDASH instruments. Normative values in the general population in Norway","volume":"39","author":"Aasheim","year":"2014","journal-title":"J Hand Surg Eur"},{"issue":"8","key":"R25-20240801","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S0883-5403(98)90195-4","article-title":"Assessing activity in joint replacement patients","volume":"13","author":"Zahiri","year":"1998","journal-title":"J Arthroplasty"},{"issue":"10","key":"R26-20240801","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1177\/0363546513496548","article-title":"Development and validation of a pediatric sports activity rating scale: the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)","volume":"41","author":"Fabricant","year":"2013","journal-title":"Am J Sports Med"},{"issue":"5","key":"R27-20240801","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1177\/0363546518756349","article-title":"The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS): normative data","volume":"46","author":"Fabricant","year":"2018","journal-title":"Am J Sports Med"},{"issue":"1","key":"R28-20240801","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.pain.2010.04.025","article-title":"Development of a PROMIS item bank to measure pain interference","volume":"150","author":"Amtmann","year":"2010","journal-title":"Pain"},{"issue":"7","key":"R29-20240801","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.jse.2018.01.014","article-title":"Validating the Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests for upper extremity fracture care","volume":"27","author":"Gausden","year":"2018","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"R30-20240801","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/j.jhsa.2014.03.013","article-title":"Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System","volume":"39","author":"D\u00f6ring","year":"2014","journal-title":"J Hand Surg Am"},{"issue":"10","key":"R31-20240801","doi-asserted-by":"crossref","first-page":"e321","DOI":"10.1097\/BOT.0000000000000924","article-title":"Longitudinal validation of the PROMIS physical function item bank in upper extremity trauma","volume":"31","author":"Kaat","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"2","key":"R32-20240801","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/0304-3959(94)90097-3","article-title":"A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales","volume":"56","author":"Price","year":"1994","journal-title":"Pain"},{"issue":"4","key":"R33-20240801","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1136\/ard.37.4.378","article-title":"Studies with pain rating scales","volume":"37","author":"Downie","year":"1978","journal-title":"Ann Rheum Dis"},{"issue":"Suppl 2 Pt 1","key":"R34-20240801","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2106\/JBJS.G.01336","article-title":"Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique","volume":"90","author":"Altamimi","year":"2008","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R35-20240801","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.pmrj.2014.09.007","article-title":"Upper limb strength: study providing normative data for a clinical handheld dynamometer","volume":"7","author":"Van Harlinger","year":"2015","journal-title":"PM R"},{"issue":"4","key":"R36-20240801","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/0363-5023(94)90280-1","article-title":"Hand strength: normative values","volume":"19","author":"Crosby","year":"1994","journal-title":"J Hand Surg Am"},{"issue":"7","key":"R37-20240801","doi-asserted-by":"crossref","first-page":"444","DOI":"10.5014\/ajot.43.7.444","article-title":"Grip strength and hand dominance: challenging the 10% rule","volume":"43","author":"Petersen","year":"1989","journal-title":"Am J Occup Ther"},{"issue":"3","key":"R38-20240801","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/BF00436775","article-title":"Bilateral differences of normal hand strength","volume":"101","author":"Reiker\u00e5s","year":"1983","journal-title":"Arch Orthop Trauma Surg"},{"issue":"6","key":"R39-20240801","first-page":"321","article-title":"Grip strength as measured by the Jamar dynamometer","volume":"51","author":"Schmidt","year":"1970","journal-title":"Arch Phys Med Rehabil"},{"issue":"14","key":"R40-20240801","first-page":"145","article-title":"The strength of the hand","volume":"10","author":"Swanson","year":"1970","journal-title":"Bull Prosthet Res"},{"issue":"3","key":"R41-20240801","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3109\/17453677908989765","article-title":"Normal grip strength","volume":"50","author":"Thorngren","year":"1979","journal-title":"Acta Orthop Scand"},{"issue":"4","key":"R42-20240801","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1054\/JHSB.1999.0236","article-title":"A comparison of dominant and non-dominant hand strengths","volume":"24","author":"Armstrong","year":"1999","journal-title":"J Hand Surg Br"},{"issue":"5","key":"R43-20240801","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/BPO.0b013e3182857d9e","article-title":"Shoulder motion, strength, and functional outcomes in children with established malunion of the clavicle","volume":"33","author":"Bae","year":"2013","journal-title":"J Pediatr Orthop"},{"issue":"8","key":"R44-20240801","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1177\/0363546516673615","article-title":"Surgical versus nonsurgical treatment for midshaft clavicle fractures in patients aged 16 years and older: a systematic review, meta-analysis, and comparison of randomized controlled trials and observational studies","volume":"45","author":"DPJ","year":"2017","journal-title":"Am J Sports Med"},{"issue":"5","key":"R45-20240801","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jse.2018.10.013","article-title":"Establishing clinically significant outcome after arthroscopic rotator cuff repair","volume":"28","author":"Cvetanovich","year":"2019","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"R46-20240801","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1177\/0363546516687541","article-title":"Defining the \u201csubstantial clinical benefit\u201d after arthroscopic treatment of femoroacetabular impingement","volume":"45","author":"Nwachukwu","year":"2017","journal-title":"Am J Sports Med"},{"issue":"5","key":"R47-20240801","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/j.arthro.2018.12.014","article-title":"Factors associated with clinically significant patient-reported outcomes after primary arthroscopic partial meniscectomy","volume":"35","author":"Gowd","year":"2019","journal-title":"Arthroscopy"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.20.00036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:36:10Z","timestamp":1787751370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.20.00036"}},"subtitle":["Internal Fixation May Improve Outcomes"],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.20.00036","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}