{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:30:57Z","timestamp":1786699857638,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"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>Introduction: Pediatric clavicle fractures are among the most common fractures in this age group. Current research supports the efficacy of nonoperative treatment for these injuries in pediatric patients. Our study seeks to examine the current trends in the management of these fractures and determine whether they align with the existing evidence-based guidelines. Methods: A retrospective analysis of pediatric patients with clavicle fractures between 1 January 2014 and 31 December 2024 was analyzed. A retrospective query was performed using the TriNetX Research Network. Patients were dichotomized into two groups based on open reduction internal fixation and nonoperative or closed treatment codes over this period, performing subgroup analyses by sex, race, and age. Results: We evaluated 78,251 patients between 10 and 18 years with clavicle fractures from 2014 to 2024, of whom 3546 underwent open reduction and internal fixation (ORIF). ORIF utilization increased from 1.62% in 2014 to 5.89% in 2024, representing a 263.6% increase from the 2014 baseline. Males consistently underwent ORIF more often than females. Adolescents (15\u201318 years) had substantially higher and faster-rising ORIF rates than younger patients (10\u201314 years), increasing from 3.4% to 12.4% versus 0.8% to 2.5% between 2014 and 2024 (APC 7.5% vs. 0%, p = 0.001). White patients had higher ORIF rates than African American patients, although some disparities narrowed over time. Conclusions: Despite limited supporting evidence, current trends demonstrate a substantial increase in the surgical management of pediatric clavicle fractures, with operative treatment rising by 263.6% by 2024. This increase in ORIF procedures may expose patients to potentially avoidable risks, including infection, anesthesia-related complications, implant-related issues, and prolonged recovery, without clearly established benefits in many cases.<\/jats:p>","DOI":"10.3390\/children13081075","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:08:29Z","timestamp":1786694909000},"page":"1075","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuing Trend of Increased Operative Treatment of Clavicle Fractures in Pediatric Patients in the United States Despite a Lack of Supporting Evidence in the Literature"],"prefix":"10.3390","volume":"13","author":[{"given":"Mahara","family":"Mohseni","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Washington University, St. Louis Children\u2019s Hospital, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jad","family":"Lawand","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Mirahmadi","sequence":"additional","affiliation":[{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Siddabattula","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Momtaz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Miami, Miami, FL 33146, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-358X","authenticated-orcid":false,"given":"Kaveh","family":"Momenzadeh","sequence":"additional","affiliation":[{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Ghali","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Javad","family":"Shariyate","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Washington University, St. Louis Children\u2019s Hospital, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooya","family":"Hosseinzadeh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Washington University, St. Louis Children\u2019s Hospital, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1302\/0301-620X.80B3.0800476","article-title":"Fractures of the clavicle in the adult. Epidemiology and classification","volume":"80","author":"Robinson","year":"1998","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_2","first-page":"373","article-title":"Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Non-operative Treatment","volume":"14","author":"Markes","year":"2022","journal-title":"Orthop. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2325967120921344","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_4","doi-asserted-by":"crossref","first-page":"23259671221126553","DOI":"10.1177\/23259671221126553","article-title":"Epidemiology of Sports-Related Clavicle Fractures in the United States: Injuries from 2015 to 2019","volume":"10","author":"Whitlock","year":"2022","journal-title":"Orthop. J. Sports Med."},{"key":"ref_5","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."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.5435\/JAAOS-D-23-00116","article-title":"An Evidence-Based Approach to Managing Adolescent (Ages 10 to 19 Years) Diaphyseal Clavicle Fractures","volume":"32","author":"Mitchell","year":"2024","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00256-023-04396-3","article-title":"A systematic review and meta-analysis on the diagnostic utility of ultrasound for clavicle fractures","volume":"53","author":"Hassankhani","year":"2024","journal-title":"Skelet. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e468","DOI":"10.5435\/JAAOS-D-17-00442","article-title":"Management of midshaft clavicle fractures in adults","volume":"26","author":"Wiesel","year":"2018","journal-title":"JAAOS-J. Am. Acad. Orthop. Surg."},{"key":"ref_9","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_10","doi-asserted-by":"crossref","unstructured":"Sassi, E., Hannonen, J., Serlo, W., and Sinikumpu, J.J. (2022). Increase in surgical fixation of pediatric midshaft clavicle fractures since 2008. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-021-04918-x"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/15563316211059101","article-title":"Rates of Operative Management of Midshaft Clavicle Fracture in Adolescents Have Increased in Florida between 2005 and 2014","volume":"18","author":"Wu","year":"2022","journal-title":"HSS J."},{"key":"ref_12","first-page":"e22.00277","article-title":"Trends in the Treatment of Adolescent Clavicle Fractures: Are We Listening to the Evidence?","volume":"7","author":"Cole","year":"2023","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1097\/01241398-200211000-00008","article-title":"Operative treatment of clavicle fractures in children: A review of 21 years","volume":"22","author":"Kubiak","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5704\/MOJ.2311.006","article-title":"Do We Ever Need to Fix Clavicle Fractures in Adolescents?","volume":"17","author":"Lim","year":"2023","journal-title":"Malays. Orthop. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1177\/17585732221131922","article-title":"Adolescent displaced lateral-end clavicle fractures are not comparable to the adult variant. Epidemiology, fracture patterns and outcome of non-operative management","volume":"15","author":"Teed","year":"2023","journal-title":"Shoulder Elb."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/BPB.0000000000000964","article-title":"Medial clavicle shaft fractures in children and adolescents: Differences from adults and management","volume":"31","author":"Whyte","year":"2022","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.1177\/03635465221114420","article-title":"Two-Year Functional Outcomes of Operative vs Non-operative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the Prospective Multicenter FACTS Study Group","volume":"50","author":"Heyworth","year":"2022","journal-title":"Am. J. Sports Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3928\/01477447-20220805-03","article-title":"Comparative Effectiveness of Non-operative Versus Operative Treatment of Completely Displaced Clavicle Shaft Fractures Among Children","volume":"45","author":"Ames","year":"2022","journal-title":"Orthopedics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001540","article-title":"The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Midshaft Clavicle Fracture Pearls and Pitfalls","volume":"33","author":"Mehlman","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s12178-019-09553-7","article-title":"Adolescent Clavicle Fractures: Is There a Role for Open Reduction and Internal Fixation","volume":"12","author":"Pandya","year":"2019","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_21","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":"JBJS"},{"key":"ref_22","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."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/BOT.0000000000001981","article-title":"Variation in treatment approaches to adolescent midshaft clavicle fractures in pediatric versus adult hospitals","volume":"35","author":"Zhang","year":"2021","journal-title":"J. Orthop. Trauma"},{"key":"ref_24","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"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1302\/1863-2548.12.170155","article-title":"Clavicle fracture nonunion in the paediatric population: A systematic review of the literature","volume":"12","author":"Hughes","year":"2018","journal-title":"J. Child. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s11420-020-09754-8","article-title":"The clavicle continues to grow during adolescence and early adulthood","volume":"16","author":"Hughes","year":"2020","journal-title":"HSS J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1302\/0301-620X.103B5.BJJ-2020-1929.R1","article-title":"Adolescent mid-shaft clavicular fracture displacement does not predict nonunion or inferior functional outcome at long-term follow-up","volume":"103-B","author":"Ng","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e20.00036","DOI":"10.2106\/JBJS.OA.20.00036","article-title":"Intermediate-term outcomes following operative and nonoperative management of midshaft clavicle fractures in children and adolescents: Internal fixation may improve outcomes","volume":"6","author":"Swarup","year":"2021","journal-title":"JBJS Open Access"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S140","DOI":"10.1016\/j.jse.2021.04.006","article-title":"Factors influencing time to return to sport following clavicular fractures in adolescent athletes","volume":"30","author":"Ahearn","year":"2021","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_30","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."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1075\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:44:36Z","timestamp":1786697076000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13081075"],"URL":"https:\/\/doi.org\/10.3390\/children13081075","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}