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Abstract

Background:

There is a paucity of data on the safety of an accelerated return-to-play (RTP) timeline after open reduction internal fixation (ORIF) of clavicular fractures in adolescent athletes, and whether patients may safely RTP before the traditional 10- to 14-week time point is unclear.

Purpose:

To assess the safety of an accelerated RTP timeline (<8 weeks) after ORIF of adolescent clavicle fractures.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This was a dual-institution, retrospective cohort study of consecutive adolescent patients (age, 10-17 years) undergoing ORIF of a midshaft or distal third clavicle fracture by 1 of 2 fellowship-trained pediatric orthopaedic surgeons from 2016 to 2024. Over the course of the study period, the senior surgeons’ practices evolved with respect to their standard-of-care RTP timelines. As a result, 2 groups of patients were available for comparison: a traditional RTP group (≥8 weeks; typically 9-13 weeks) and an accelerated RTP group (<8 weeks; typically 5-7 weeks). Patient, injury, and surgical details were collected. The primary outcome was refracture/nonunion at 6 months postoperatively. Additional analyzed outcomes included infection and wound complications.

Results:

There were 54 patients, including 27 (50.0%) undergoing an accelerated RTP timeline and 27 (50.0%) undergoing a traditional RTP timeline. There were no significant differences in any patient, injury, or surgical characteristic between groups, including age (14.4 vs 14.6 years; P = .80), sex (74.1% vs 85.2% male; P = .31), or proportion planning to return to a contact sport at the time of RTP clearance (80.0% vs 78.3%; P > .99), among others. Patients in the accelerated cohort returned to play more quickly than patients in the traditional cohort (mean, 6.1 ± 1.1 vs 11.7 ± 3.0 weeks; P < .001; accelerated RTP timeline range, 3.1-7.7 weeks). Among the 27 patients undergoing the accelerated RTP protocol, 3.7% returned by 3 to 4 weeks, 18.5% by 4 to 5 weeks, 40.7% by 5 to 6 weeks, 81.5% by 6 to 7 weeks, and 100% by 7 to 8 weeks. There were no (0%) refractures/nonunions in the accelerated RTP cohort compared with 1 (3.7%) in the traditional RTP cohort (P > .99). There were no instances of infection or wound complications in either group.

Conclusion:

Accelerated RTP after ORIF of adolescent clavicle fractures was not associated with a significantly increased risk of refracture/nonunion or other complications compared with a more traditional RTP timeline. The mean time to RTP in the accelerated RTP group was 6.1 weeks, with patients being cleared to RTP as soon as 3.1 weeks postoperatively. These data suggest that carefully indicated adolescent patients undergoing ORIF of clavicle fractures can RTP more quickly than previously thought. Replication of these results in additional cohorts is necessary before accelerated RTP becomes a relative indication for ORIF of these injuries.

Keywords

clavicle fracture return to sport return to play fast accelerated open reduction internal fixation

Clavicle fractures are a common cause of orthopaedic injury in children and adolescents, accounting for 10% to15% of all pediatric fractures.^11,18 Furthermore, data suggest that clavicle fractures occur at least twice as often in adolescents compared with any other age group,²⁴ with male athletes at the greatest risk.^6,16 While the majority of these injuries may be managed nonoperatively, open reduction internal fixation (ORIF) is sometimes warranted due to fracture- or patient-specific factors.

Relative indications for ORIF of closed adolescent clavicle fractures remain under debate, and there are no randomized controlled trials (RCTs) comparing operative and nonoperative management in the pediatric literature.^17,20 However, epidemiological data demonstrate a clear trend of increasing utilization of ORIF for these injuries.^{6,12,14,27,31,36} For example, at the end of the 20th century an estimated 1.6% of pediatric clavicle fractures underwent operative fixation¹⁴ compared with roughly 17% from 2013 to 2016.⁶ These trends are likely driven in part by recent RCTs supporting the use of ORIF for displaced clavicle fractures in adults.^5,17,20

Given the growing use of ORIF in adolescent patients with clavicle fractures, determination of optimal postoperative regimens is increasingly important to not only maximize outcomes after surgery but also appropriately counsel patients before surgery. Notably, there is little data evaluating the optimal return-to-play (RTP) timeline after ORIF of adolescent clavicle fractures, with most studies using historical standards of 10 to 14 weeks.^{1,9,14,17,29,32} Given these results, a recent review¹⁷ on the management of adolescent clavicle fractures concluded, “from an evidence-based perspective, quicker return to sports should not be emphasized to patients/families as a benefit of surgical management.” However, to our knowledge, there are no studies evaluating an accelerated RTP timeline compared with historical standards among adolescent patients undergoing ORIF of clavicle fractures. Therefore, the purpose of this study was to investigate the safety profile of an accelerated RTP timeline after anatomic ORIF of adolescent clavicle fractures. We hypothesized that an accelerated RTP timeline (<8 weeks) would not be associated with an increased risk of complications and that patients may be able to safely RTP within 6 weeks or sooner.

Methods

This was a dual-institution, retrospective cohort study of consecutive adolescent patients undergoing anatomic ORIF of a clavicle fracture from 2016 to 2024 by 2 fellowship-trained pediatric orthopaedic surgeons (M.A.S., P.D.F.) specializing in sports medicine. The institutions were geographically diverse with respect to urban/rural locale. After institutional review board approval was obtained at each institution, a data-sharing agreement was completed between hospitals.

Inclusion criteria consisted of adolescent patients (10-17 years) undergoing ORIF of a midshaft or distal third clavicle fracture with a minimum 6-month follow-up. This follow-up time frame was chosen for the study question as it allows for complete evaluation of differences between a traditional and accelerated RTP timeline with respect to reinjury risk, and it has been used widely in the orthopaedic literature for evaluation of reinjury/nonunion after clavicle fractures.^{2,19,22,25,26} By 6 months, the fracture will have either healed or refractured/experienced nonunion, and any differences emerging beyond this point would not be due to the RTP timelines. Given the potential for the management of concomitant fractures to prolong RTP, exclusion criteria consisted of polytrauma patients with other fractures (n = 1).

Over the course of the study period, the senior surgeons’ practices evolved with respect to their standard-of-care RTP timelines for patients with otherwise routine healing (healed incision, full painless range of motion, no tenderness to palpation, and no radiographic complication). As a result, 2 groups of patients were available for comparison: a traditional RTP group (≥8 weeks; typically 9-13 weeks) and an accelerated RTP group (<8 weeks; typically 5-7 weeks). The RTP timeline was defined as the time from the date of surgery to the time the patient was given full clearance for unrestricted contact sports.

For all patients, electronic medical records were reviewed. Demographic factors collected included age, sex, arm dominance, and intention to actually return to a contact (vs noncontact) sport at the time the patient was given full RTP clearance for contact sports. Injury factors collected included injury date, laterality, location, displacement, shortening, and sport/activity during injury. Surgical factors collected included plate type, number, configuration, and size.

The primary outcome of this study was the difference in incidence of refracture/nonunion at 6 months between accelerated and traditional RTP timelines. Secondary outcomes included complications and removal of hardware (ROH). Complications were defined as refracture, nonunion, hardware changes, deep infection, wound complications, or superficial surgical site infection. For any patients experiencing a complication, timing, treatment, and mechanistic details were collected. As ROH is routinely offered to all patients on an elective basis in both surgeons’ practices, regardless of symptoms, this was not considered a complication.

Surgical indications included comminution with ≥3 fragments, shortening >2 cm, or threatened skin. Surgical technique was dictated by the optimal treatment necessary for each patient's injury pattern and thus inherently differed between patients. Nevertheless, a standard anterior or superior approach to the clavicle was performed in all cases. Fixation was performed with a single plate (either anterior or superior), dual plates (orthogonally anterior and superior), or a suture-based construct for certain distal third fractures. Postoperatively, patients were made nonweightbearing in a sling for 2 weeks with distal range of motion as tolerated and encouraged to perform home pendulum exercises. After 2 weeks, active shoulder range of motion and strengthening began, with patients allowed to advance weightbearing as tolerated.

Statistical Analysis

Unless otherwise noted, continuous variables are presented as mean ± standard deviation and compared using independent-samples Student t tests or Mann-Whitney U tests based on normality distributions. Categorical variables are presented as number (percent) and compared using chi-square or Fisher exact tests, as appropriate. All analyses were performed in SAS Version 9.4 (SAS Institute), and a 2-tailed threshold P value ≤.05 was considered statistically significant.

Results

Patient, Injury, and Surgical Characteristics

A total of 54 adolescent patients underwent clavicle ORIF with mean follow-up of 19.2 months, including 27 (50.0%) with an accelerated RTP timeline and 27 (50.0%) with a traditional RTP timeline. There were no significant differences in any baseline patient factors between the accelerated and traditional RTP groups, including with respect to age (mean, 14.4 ± 1.8 vs 14.6 ± 1.7 years; P = .80), sex (74.1% vs 85.2% male; P = .31), injury to the dominant arm (75.0% vs 52.2%; P = .10), or proportion planning to return to a contact sport at the time of RTP clearance (80.0% vs 78.3%; P > .99) (Table 1). The specific sports or activities during which the injuries were sustained are presented in Table 2, with football (22.2%), mountain biking/bicycle accidents (16.7%), and skateboarding/skating (9.3%) injuries being most common.

Table 1

Patient, Injury, and Surgical Characteristics Between Adolescents Undergoing an Accelerated (<8 Weeks) Versus Traditional (≥8 Weeks) RTP Timeline After ORIF of a Clavicle Fracture ^a

	Timeline
Characteristic	Accelerated (n = 27)	Traditional (n = 27)	P
Age, y	14.4 (1.8)	14.6 (1.7)	.8
Sex			.31
Male	20 (74.1)	23 (85.2)
Female	7 (25.9)	4 (14.8)
Laterality			.78
Left	18 (66.7)	17 (63.0)
Right	9 (33.3)	10 (37.0)
Dominant side	18 (75.0)^b	12 (52.2)^c	.1
Location			>.99
Midshaft	23 (85.2)	23 (85.2)
Distal third	4 (14.8)	4 (14.8)
Displacement, shaft widths	1.4 (0.6)	1.5 (0.5)	.48
Shortening, mm	23.1 (9.4)	18.9 (7.0)	.12
Construct type			>.99
Plate	26 (96.3)	26 (96.3)
Suture	1 (3.7)	1 (3.7)
Days from injury to surgery	7.9 (4.3)	6.3 (4.9)	.22
Returning to contact sport	20 (80.0)^d	18 (78.3)^c	>.99
Time to RTP, wk	6.1 (1.1)	11.7 (3.0)	<.001

Continuous variables are reported as mean (SD). Categorical variables are reported as n (%). Bold P value indicates statistical significance (P≤ .05). ORIF, open reduction internal fixation; RTP, return to play.

Of 24 patients with arm dominance data from which ipsilateral dominant side injury could be ascertained.

Of 23 patients with arm dominance data from which ipsilateral dominant side injury could be ascertained.

Of 25 patients with arm dominance data from which ipsilateral dominant side injury could be ascertained.

Table 2

Sport or Activity During Which Patients Sustained the Clavicle Fracture ^a

Sport/Activity	n (%)
Football	12 (22.2)
Mountain biking/bike accident	9 (16.7)
Skating/skateboarding	5 (9.3)
Soccer	4 (7.4)
Motorcross	3 (5.6)
ATV	2 (3.7)
Basketball	2 (3.7)
Golf cart	2 (3.7)
Hockey	2 (3.7)
Running (ground-level fall)	2 (3.7)
Skiing/snowboarding	2 (3.7)
Field hockey	1 (1.9)
Ground-level fall on ice	1 (1.9)
Lacrosse	1 (1.9)
Motor vehicle accident	1 (1.9)
Pedestrian struck	1 (1.9)
Scooter	1 (1.9)
Sledding	1 (1.9)
Softball	1 (1.9)
Wrestling	1 (1.9)

ATV, all-terrain vehicle.

There were similarly no significant differences in injury or surgical characteristics between accelerated and traditional patients, including laterality (66.7% vs 63.0% left; P = .78), location (85.2% vs 85.2% midshaft; P > .99), shortening (23.1 ± 9.4 vs 18.9 ± 7.0 mm; P = .12), displacement (1.4 ± 0.6 vs 1.5 ± 0.5 shaft widths; P = .48), time from injury to surgery (7.9 ± 4.3 vs 6.3 ± 4.9 days; P = .22), or the use of plate or suture-based constructs (96.3% vs 96.3% plate; P > .99; 1 [3.7%] suture-based construct in each group) (Table 1). Individual construct configurations are listed in Table 3, with orthogonal plating using a combination of 2.4-mm and/or 2.7-mm plates being the most commonly used construct (used in 66.7% of patients).

Table 3

Specific Fixation Constructs Used ^a

Fixation Construct	n (%)
Orthogonal 2.7- and/or 2.4-mm plates	23 (42.6)
Single 2.7-mm anterior plate	12 (22.2)
Orthogonal 2.4- and/or 2.7-mm plates	8 (14.8)
Orthogonal 2.7- and/or 2.7-mm plates	4 (7.4)
Single 2.7-mm T-plate	3 (5.6)
Suture-based construct	2 (3.7)
Orthogonal 2.4- and/or 2.4-mm plates	1 (1.9)
Single 3.5-mm superior plate	1 (1.9)

Orthogonal plates are listed in the format of superior plate and/or anterior plate.

Return to Play

In terms of time to RTP, patients in the accelerated cohort returned to play significantly earlier than patients in the traditional cohort (P < .001). Specifically, accelerated RTP patients returned at a mean of 6.1 ± 1.1 weeks (median, 6.4 weeks; interquartile range, 5.4-6.9 weeks; range, 3.1-7.7 weeks) compared with a mean of 11.7 ± 3.0 weeks (median, 11.0 weeks; interquartile range, 9.7-12.4 weeks; range, 8.1-21.4 weeks) for patients in the traditional cohort (P < .001). Among the 27 patients undergoing the accelerated RTP protocol, 3.7% returned by 3 to 4 weeks, 18.5% by 4 to 5 weeks, 40.7% by 5 to 6 weeks, 81.5% by 6 to 7 weeks, and 100% by the 7- to 8-week time frame.

Outcomes

The overall complication rate was 3.7% (2/54 patients), both of which occurred in the traditional RTP cohort (7.4%; 2/27 patients). There were no significant differences between the accelerated versus traditional RTP groups with respect to any complications within the numbers available for study (Table 4). Specifically, there was no significant difference in the incidence of refracture/nonunion (0% vs 3.7%; P > .99), deep infection (0% vs 0%, P > .99), superficial surgical site infection (0% vs 0%; P > .99), or hardware changes (0% vs 3.7%; P > .99) between patients in the accelerated versus traditional RTP cohorts.

Table 4

Incidence of Complications and Removal of Hardware Between Adolescents Undergoing an Accelerated (<8 Weeks) Versus Traditional (≥8 Weeks) RTP Timeline After ORIF of a Clavicle Fracture ^a

	Timeline
Event	Accelerated (n = 27)	Traditional (n = 27)	P
Any complication	0 (0.0)	2 (7.4)	.49
Refracture/nonunion	0 (0.0)	1 (3.7)	>.99
Deep infection	0 (0.0)	0 (0.0)	>.99
Superficial surgical site infection	0 (0.0)	0 (0.0)	>.99
Other wound complication	0 (0.0)	0 (0.0)	>.99
Hardware change	0 (0.0)	1 (3.7)	>.99
Removal of hardware	4 (14.8)	9 (33.3)	.11

Data are presented as n (%). ORIF, open reduction internal fixation; RTP, return to play.

The 1 refracture occurred in a traditional RTP timeline patient treated with orthogonal 2.4-mm plates who was cleared to RTP at 9.1 weeks postoperatively. At the time of that visit, he had full, pain-free range of motion, no tenderness to palpation, and radiographic imaging that appeared to depict a complete osseous union with no fracture line visible. Nine days later (10.4 weeks postoperatively), he was tackled while playing “tag” and experienced refracture. It was subsequently discovered that he had been regularly shooting a shotgun with the stock on the operative shoulder since the 2-week postoperative time point. He was treated with revision ORIF and healed without further incident. The 1 hardware change was a bent plate that occurred in a traditional RTP timeline patient treated with a single 2.7-mm anterior plate after falling on the operative shoulder in the second postoperative week. Fracture alignment remained adequate, and this patient healed without issue or further intervention.

The overall incidence of ROH was 24.1%, which occurred at a mean of 11.0 ± 5.3 months postoperatively. ROH rates did not significantly differ between the accelerated (14.8%) and traditional (33.3%) RTP groups (P = .11). Additionally, there was no significant association between fixation construct and the incidence of ROH within the numbers available for this study (P = .48). Specifically, ROH occurred in 8 of 36 (22.2%) patients with orthogonal plates, 3 of 12 (25%) with a single 2.7-mm anterior plate, 1 of 1 (100%) with a single 3.5-mm superior plate, 1 of 3 (33.3%) with a single 2.7-mm superior T-plate, and 0 of 2 (0%) with suture-based constructs.

Discussion

The most important finding of this study was that accelerated RTP (mean, 6.1 weeks) after ORIF of adolescent clavicle fractures was not associated with a significantly increased risk of refracture/nonunion compared with a more conservative historical timeline (mean, 11.7 weeks). Traditionally, consensus guidelines have recommended an RTP timeline of 10 to 14 weeks after surgery,¹⁷ with surgeons’ operative RTP timelines often being relatively similar to their nonoperative counterparts. For instance, in a study of 42 adolescent clavicle fractures (17 operative, 25 nonoperative), Vander Have et al³² found that the mean time to return to activities was 16 weeks in the nonoperative group and 12 weeks in the operative group. Similarly, among 60 older adolescent athletes with severely shortened or comminuted clavicle fractures (35 operative, 25 nonoperative), Spence et al²⁹ found a mean time to RTP of 13.5 weeks in the nonoperative group and 10.1 weeks in the operative group. In a series of 78 adolescent clavicle fractures (46 operative, 32 nonoperative), Hagstrom et al⁹ reported an RTP of 12.2 weeks in the nonoperative group and 12.7 weeks in the operative group. More recently, Ahearn et al¹ reported that operatively treated fractures had an even longer RTP than nonoperatively treated fractures (14.2 vs 8.7 weeks). While these studies are provided solely as reference data for historical RTP timelines after operative management of adolescent clavicle fractures, an important caveat to consider when interpreting the comparisons in these studies is that RTP timelines are determined by the operating surgeon and do not necessarily differ between operative and nonoperative groups. As such, these findings do not inherently demonstrate anything about when patients could have returned to play, but rather that—in the absence of alternative data—surgeons have historically used slower RTP timelines similar to nonoperative protocols.

Nevertheless, the results of the current study are not entirely unprecedented. In a case series of 23 adolescent clavicle ORIFs, Kamaci et al¹³ reported a mean RTP time of 6.5 weeks and no refractures/nonunions. In their narrative review on adolescent clavicle fractures, Patel et al²⁰ described a 14-year-old golfer that they treated with ORIF who returned to competitive golf 5 weeks postoperatively. When taken in conjunction with the findings of the current study of the largest cohort of patients with an accelerated RTP timeline and the first with a comparative group to traditional RTP timelines, the implications of these results are multifold. First, there is now preliminary evidence for surgeon confidence in allowing patients with otherwise routine recoveries (eg, no pain or radiographic complications) to RTP much earlier than historical consensus suggests.¹⁷ By doing so, patients may not be unnecessarily withheld from gym and athletic activities, which at a minimum can prevent unneeded de-conditioning and at best may improve pediatric mental health.^3,30 Second, when adolescent patients have clavicle fractures, surgeons have better data to counsel patients and families about the possible RTP timelines should patients proceed with surgery, which can improve preoperative decision-making for both patients and surgeons. Finally, if these results are replicated in additional cohorts, it is possible that accelerated RTP may ultimately prove to be a relative indication for clavicle ORIF in high-level adolescent athletes hoping to RTP within the same season, similar to phalangeal,^7,8,28 distal radius,⁴ and fifth metatarsal base fractures³⁴ in adult athletes. However, we would caution against that at this time until these results are replicated in additional cohorts.

How quickly adolescents can ultimately RTP after clavicle ORIF is still an open question. The fastest timeline in our cohort was a highly touted 16-year-old high school football recruit treated with orthogonal 2.4- and 2.7-mm plates. After extensively counseling him and his parents on the relative risks and benefits, he was cleared to RTP for his high school football playoffs at 3.1 weeks postoperatively, in which he played without issue. There are anecdotal reports of similar RTP timelines among other high-profile collegiate football players, with return to practice as early as 10 days and full-contact competition at 20 days.³⁵ In considering the lower bound for RTP clearance in our experience, at a minimum, the wound must be fully healed. Patients should also be assessed for pain on examination (both tenderness and pain with active range of motion), which is typically present for at least 3 to 4 weeks. After that point, if the patient has full, pain-free range of motion without tenderness and no evidence of complication on radiographic imaging, there is little evidence to suggest a gradual commencement of activity is contraindicated. Full RTP clearance is then possible once the athlete has completed full physical and neurocognitive reacclimatization. That said, the risks and benefits of accelerated RTP should be weighed and discussed carefully with patients and families, and there is likely rarely a need to clear patients before 4 to 6 weeks.

A secondary finding of this study was the overall favorable complication profile after ORIF of adolescent clavicle fractures, which is consistent with previous results.^10,20 For example, in the large, prospective multicenter FACTS (Function after Adolescent Clavicle Trauma and Surgery) cohort, Heyworth et al¹⁰ found a 0% rate of superficial surgical site infection, 0% rate of deep infection, 3.2% rate of delayed union, and 0% rate of nonunion among 125 adolescents undergoing ORIF of a midshaft clavicle fracture, each of which is quite similar to the incidences seen in the current report. On the other hand, only 4.8% patients in that cohort underwent ROH, compared with 24.1% in the current study. The current ROH results are more consistent with other studies such as those by Kamaci et al¹³ (18.8%) and Leroux et al¹⁵ (18.8% in an adult population). This difference likely reflects differences in practice patterns between studies, as ROH was only performed on a subset of symptomatic patients in the FACTS study¹⁰ while it was routinely offered to all patients in our practice. Regardless of the exact rate, the potential for subsequent ROH is something that patients and families should be counseled on before undergoing clavicle ORIF.

Interestingly, we found no clear association between plate size, location, or number and the incidence of ROH. While this study was not specifically powered to determine these associations, this finding is likely due to 2 factors. First, given that all patients were offered ROH, undergoing ROH in this study did not inherently reflect having symptomatic hardware. Second, all but one of the plates used in this study was a small, low-profile mini-fragment plate. Regardless of location (anterior or superior), size (2.4 mm or 2.7 mm), or number (single or dual orthogonal), these plates are much less likely to be felt by patients compared with traditional, bulkier 3.5-mm plates. Notably, the 1 patient who underwent ORIF with a single superior 3.5-mm plate in this study did require ROH. These findings are consistent with a recent study in the adult literature by Reddy et al,²³ which showed that single plating with a 3.5-mm superior or anterior plate had an 8.4-fold or 6.8-fold increased risk of ROH, respectively, compared with orthogonal plating with mini-fragment plates. While these findings have not yet been replicated in the pediatric literature, it is likely that the use of mini-fragment plates also reduces the incidence of symptomatic hardware in this population, who may be even more prone to hardware prominence.

Limitations

This study is not without limitations. First, as a retrospective cohort study, causality cannot be confirmed.³³ Nevertheless, there were no differences observed in any patient or surgical factors between groups to suggest that underlying confounding is likely to play a significant role. Second, these results should not be extrapolated to proximal third clavicle fractures as these patients were not included in this study and may require longer RTP timelines. Third, given the relative rarity with which these injuries undergo operative treatment, power was inherently limited. However, this study is substantially larger than other recent high-profile studies on adolescent clavicle fractures,^1,13,21 provides a sufficiently large sample to demonstrate that accelerated RTP does not lead to a dramatically increased risk of complications, and, to our knowledge, is one of the largest, if not the largest, samples of operatively treated clavicle fractures with RTP timing ever reported. Still, surgeons should remain careful in clearing patients for accelerated RTP, and this study may serve as the basis for additional reports to investigate this question. Fourth, we considered excluding suture-based constructs given the low number (1 patient in each group). While doing so would not change any conclusions, we thought it was most informative to the orthopaedic community to include these patients as it highlights that they too can undergo an accelerated RTP timeline. Fifth, our ROH analysis was only exploratory; it is possible that differences in this outcome could have existed at a longer follow-up. Finally, patient-reported outcome data were not available. As RTP timing is driven by the need to avoid complications (principally refracture/nonunion), this limitation has little to no bearing on the ability of this study to answer the relevant clinical question.

Conclusion

Accelerated RTP after ORIF of adolescent clavicle fractures was not associated with a significantly increased risk of refracture/nonunion or other complications compared with a more traditional RTP timeline. The mean time to RTP in the accelerated RTP group was 6.1 weeks, with patients being cleared to RTP as soon as 3.1 weeks postoperatively. These data suggest that carefully indicated adolescent patients undergoing anatomic ORIF of clavicle fractures can RTP more quickly than previously thought. Replication of these results in additional cohorts is necessary before accelerated RTP becomes a relative indication for ORIF of these injuries.

Footnotes

Final revision submitted May 14, 2025; accepted June 16, 2025.

One or more of the authors has declared the following potential conflict of interest or source of funding: M.A.S. receives IP royalties from and is a paid consultant for Orthopaediatrics. P.D.F. is associate editor of Clinical Orthopedics and Related Research, is a consultant for BICMD, receives publishing royalties from Springer Nature, and receives stock or stock options from OssoVR. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Ethical approval for this study was obtained from Hospital for Special Surgery (Study No. 2023-2468).

ORCID iD

Nathan H. Varady

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Safety of Accelerated Return to Play After Anatomic Open Reduction and Internal Fixation of Adolescent Clavicle Fractures

Abstract

Background:

Purpose:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Methods

Statistical Analysis

Results

Patient, Injury, and Surgical Characteristics

Return to Play

Outcomes

Discussion

Limitations

Conclusion

Footnotes

ORCID iD

References