ArticleJournal of orthopaedic surgery and research2026
Titanium elastic nail fixation versus conservative treatment for displaced mid-shaft clavicle fractures in adolescent athletes stratified according to sport function: a multicenter retrospective cohort study.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo systematically compare the efficacy of titanium elastic nailing (TEN) versus conservative treatment for displaced mid-shaft clavicle fractures in adolescent athletes, with emphasis on return-to-sport time, season loss, and functional recovery, and to evaluate the value of a sport-type stratification model based on clavicle biomechanical demands in therapeutic decision-making.
methodsA multicenter retrospective cohort study was conducted, enrolling 96 adolescent athletes with acute, unilateral mid-shaft clavicle fractures and displacement ≥ 2 cm. Patients were divided into surgical (n = 54) and conservative treatment (n = 42) groups. Athletes were stratified into four subgroups based on clavicle functional demand in their sports: structure-dependent, kinetic-dependent, coordination-dependent, and function-independent. Within the surgical group, 13 athletes were in structure‑dependent sports, 10 in kinetic‑dependent sports, 21 in coordination‑dependent sports, and 10 in function‑independent sports; within the conservative group, 15 were in structure‑dependent sports, 6 in kinetic‑dependent sports, 14 in coordination‑dependent sports, and 7 in function‑independent sports. Primary endpoints included time to return to training, time to return to competition, and days of season loss. Secondary endpoints included Numeric Pain Rating Scale (NPRS), Constant-Murley shoulder score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Tampa Scale for Kinesiophobia (TSK).
resultsThe median time to return to competition was 38 days in the surgical group, significantly shorter than in the conservative group (P < 0.05), with an average reduction in season loss of 7-10 days. Subgroup analysis revealed that surgical treatment significantly shortened return-to-sport times in structure- and kinetic-dependent sports, whereas no significant differences were observed in coordination- or function-independent sports. Early postoperative scores (2-4 weeks) for NPRS, Constant-Murley, DASH, and TSK were superior in the surgical group (P < 0.05); however, all functional and psychological scores converged at 1-year follow-up, with no statistically significant differences. Complication rates were low, with only one case of minor wound reaction in the surgical group.
conclusionFor adolescent athletes engaged in structure- or kinetic-dependent sports with high clavicle functional demand, TEN fixation significantly accelerates return to sport, reduces season loss, and enhances early functional and psychological recovery, while achieving long-term functional outcomes equivalent to conservative treatment. The proposed decision model integrating "season time window" and "sport-type stratification" overcomes the limitations of traditional displacement-based criteria and provides evidence-based support for individualized management of clavicle fractures in adolescent athletes.
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