Summary

No increased risk of refracture or complications among adolescents with an accelerated return to play timeline after ORIF of a midshaft clavicle fracture, with patients returning to contact sports as quickly as 5.7 weeks postoperatively.

Abstract

Introduction

Clavicle fractures are a leading cause of injury among adolescent athletes. While the majority of these injuries may be managed nonoperatively, open reduction internal fixation (ORIF) is sometimes warranted. Traditional consensus for return to play (RTP) following clavicle ORIF is 12-16 weeks. To date, however, there are no data on whether patients may safely RTP before this time point. Therefore, the purpose of this study was to assess the safety of an accelerated RTP timeline following ORIF of adolescent clavicle fractures.

Methods

This was a retrospective cohort study of consecutive adolescent patients (age 12-17 years) undergoing ORIF of a midshaft clavicle fracture from 2016 to 2024 by a single pediatric sports medicine orthopaedic surgeon with minimum 6-month follow-up. The senior surgeon traditionally allowed RTP consistent with historical guidance of 12-16 weeks postoperatively, before shifting to an accelerated RTP timeline of 6-10 weeks at the approximate midpoint of the study period (September 2020). Consecutive patients before and after this shift were reviewed to minimize confounding (i.e., patients were effectively randomized in time to a traditional or accelerated RTP timeline; there were no other changes in surgical technique, indications, or rehabilitation protocol between periods). Demographic, injury, and surgical details were collected. Time to RTP was defined as the time from surgery to the time the patient was given full clearance for contact sports. The primary outcome was refracture. Additional outcomes included infection, wound complications, and removal of hardware. Results were compared between the accelerated (typically 6-10 weeks) and traditional (typically 12-16 weeks) RTP cohorts with Fisher exact or Student t-tests, as appropriate.

Results

There were 23 patients (0% loss to follow-up), including 12 patients in the accelerated RTP group and 11 patients in the traditional RTP group. There were no differences in sex (83.3% vs. 90.9% male, p>0.99), age (mean 14.8 years vs. 15.3 years, p=0.47), shortening (mean difference 0.4 mm, p=0.88), displacement (mean 1.3 shaft widths vs. 1.5 shaft widths, p=0.40), or fixation strategy (100% dual plate vs. 90.9% dual plate, p=0.48) between the accelerated vs. traditional groups. Patients in the accelerated cohort (mean 8.7 [95% CI 7.4-10] weeks; range 5.7-11.0 weeks) returned to play significantly more quickly than those in the traditional cohort (mean 13.0 [95% CI 11.6-14.4] weeks; range 10.9-18 weeks) (p<0.001). There were no refractures in either group (0.0% vs. 0.0%, p>0.99). Similarly, there were no differences in infection (0.0% vs. 0.0%, p>0.99), wound complications (0.0% vs. 0.0%, p>0.99), or removal of hardware (16.7% vs 27.3%, p=0.64) between groups.

Conclusions

In this first study to investigate the safety of an accelerated RTP timeline following ORIF of adolescent midshaft clavicle fractures, accelerated RTP was not associated with an increased risk of refracture or other complications. The mean time to RTP in the accelerated RTP group was 8.7 weeks, with patients being cleared to RTP as quickly as 5.7 weeks postoperatively. These data suggest that adolescent patients undergoing ORIF of midshaft clavicle fractures with dual plates may be able RTP more quickly than previously thought.