{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:10Z","timestamp":1760060710840,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: There are differing opinions in the literature regarding the optimal treatment modality for adolescents with completely displaced, complex clavicle fractures. This study aims to determine outcome differences between surgical and non-surgical treatment for adolescent Z-type clavicle fractures and to ascertain if differences exist in outcomes between the two interventions. Methods: This was a single-center, retrospective chart review performed at a level 1 trauma center. Inclusion criteria included pediatric patients ages 12 to 16 years who presented with a comminuted, displaced clavicle shaft fracture with a comminuted fragment more than 1 cm in length and were treated either operatively or nonoperatively between January 2019 and December 2022. The outcomes were radiographic union status (i.e., union versus non-union versus malunion), follow-up period, shoulder range of motion, return to athletic activities, and patient reported pain level. Results: Of the 24 patients, 11 were treated surgically and 13 non-surgically. Patients who were treated surgically were more likely to be older (mean 1.5 years, p = 0.039) and have a longer follow-up by 9 months average duration compared to the cohort treated non-surgically (p = 0.0009). There was no significant difference between patient reported pain, radiographic union status, return to athletic activity, or shoulder range of motion between the cohorts. The small sample size and retrospective study design limits the statistical power of our results. Conclusions: The decision between treating these complex fractures operatively versus nonoperatively should be left to a lengthy discussion between the surgeon, parents, and the patient.<\/jats:p>","DOI":"10.3390\/children12101278","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T08:09:42Z","timestamp":1758614982000},"page":"1278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Operative Versus Nonoperative Treatment of Z-Type Clavicle Shaft Fractures in Adolescents: A Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7052-8105","authenticated-orcid":false,"given":"Iulia","family":"Dobrin","sequence":"first","affiliation":[{"name":"School of Medicine, Oakland University William Beaumont, Rochester, MI 48309, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Van Wagoner","sequence":"additional","affiliation":[{"name":"School of Medicine, Oakland University William Beaumont, Rochester, MI 48309, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Azeroual","sequence":"additional","affiliation":[{"name":"School of Medicine, Oakland University William Beaumont, Rochester, MI 48309, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Leider","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, William Beaumont University Hospital, School of Medicine, Oakland University William Beaumont, Royal Oak, MI 48073, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehab","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, William Beaumont University Hospital, School of Medicine, Oakland University William Beaumont, Royal Oak, MI 48073, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref_1","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 Jt. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1097\/BPO.0000000000000757","article-title":"Surgical Treatment of Adolescent Clavicle Fractures: Results and Complications","volume":"36","author":"McIntosh","year":"2016","journal-title":"J. Pediatr. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5397\/cise.2021.00388","article-title":"Current concepts in the treatment of midshaft clavicle fractures in adults","volume":"24","author":"Song","year":"2021","journal-title":"Clin. Shoulder Elb."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"301","DOI":"10.55275\/JPOSNA-2021-301","article-title":"Operative Versus Nonoperative Treatment of Z-Type Comminuted Clavicle Fractures in Adolescents: A Substratified Cohort Analysis","volume":"3","author":"Sabatini","year":"2021","journal-title":"J. Pediatr. Orthop. Soc. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BPO.0b013e31825870ad","article-title":"Clavicle Shaft Fractures: Are Children Little Adults?","volume":"32","author":"Caird","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.5435\/JAAOSGlobal-D-22-00277","article-title":"Trends in the Treatment of Adolescent Clavicle Fractures: Are We Listening to the Evidence?","volume":"7","author":"Cole","year":"2023","journal-title":"JAAOS Glob. Res. Rev."},{"key":"ref_7","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."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3928\/01477447-20220805-03","article-title":"Comparative Effectiveness of Nonoperative Versus Operative Treatment of Completely Displaced Clavicle Shaft Fractures Among Children","volume":"45","author":"Ames","year":"2022","journal-title":"Orthopedics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1177\/03635465241228818","article-title":"5-Year Radiographic and Functional Outcomes of Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers","volume":"52","author":"Polinsky","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_10","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":"Perdue","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_11","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."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/BPO.0000000000001768","article-title":"Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study","volume":"41","author":"Riiser","year":"2021","journal-title":"J. Pediatr. Orthop."},{"key":"ref_13","first-page":"373","article-title":"Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment","volume":"14","author":"Markes","year":"2022","journal-title":"Orthop. Res. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1097\/BPO.0b013e3181c29c9c","article-title":"Operative Treatment of Completely Displaced Clavicle Shaft Fractures in Children","volume":"29","author":"Mehlman","year":"2009","journal-title":"J. Pediatr. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/BPB.0000000000000301","article-title":"Trends in the volume of operative treatment of midshaft clavicle fractures in children and adolescents: A retrospective, 12-year, single-institution analysis","volume":"25","author":"Suppan","year":"2016","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"232596712092134","DOI":"10.1177\/2325967120921344","article-title":"Descriptive Epidemiology of Adolescent Clavicle Fractures: Results From the FACTS (Function after Adolescent Clavicle Trauma and Surgery) Prospective, Multicenter Cohort Study","volume":"8","author":"Ellis","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/BPO.0000000000000258","article-title":"Treatment Trends in Adolescent Clavicle Fractures","volume":"35","author":"Yang","year":"2015","journal-title":"J. Pediatr. Orthop."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/10\/1278\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:27Z","timestamp":1760035647000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/10\/1278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":17,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["children12101278"],"URL":"https:\/\/doi.org\/10.3390\/children12101278","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}