Consensus on the Treatment of Midshaft Clavicular Fractures in Collegiate Football Players: A Delphi Approach of Sports Medicine Teams.

Background: Optimal management of clavicular fractures in football players remains unclear. Purpose: To utilize the Delphi process to (1) identify factors used in decision-making for clavicular fractures in collegiate football players, (2) investigate the current use of bone stimulators, teriparatide, and specialized padding as adjuncts to treatment, and (3) determine areas of consensus for treatment. Study Design: Consensus statement. Methods: A total of 83 orthopaedic surgeons, nonsurgical sports medicine physicians, and athletic trainers from the Southeastern Conference were surveyed utilizing a 3-round Delphi process. The first 2 rounds identified the most important factors that influenced treatment. These factors were combined to create 48 clinical scenarios. In the third round, panelists were presented with 8 treatment options for each scenario. Treatment options were scored as "preferred treatment,""acceptable treatment,""not acceptable/contraindicated," or "unsure/no opinion." The threshold for consensus was set at 75%. Additional questions investigated panelists' methods for measuring displacement and shortening as well as their use of bone stimulators, teriparatide, and specialized pads. Results: All 3 rounds were completed by 43 panelists (24 orthopaedic surgeons, 4 nonoperative sports medicine physicians, and 5 athletic trainers). The top 4 factors that influenced treatment in descending order were (mean score: 1, most important; 7, least important) amount of displacement (1.16), fracture location (3.60), player input (4.07), and return-to-play timeline (4.16). Bone stimulators and specialized pads were commonly used, but teriparatide was used less frequently. Consensus analysis in round 3 only analyzed results from orthopaedic surgeons because of low response rates from nonoperative sports medicine physicians (15.4%) and athletic trainers (22.7%) compared with orthopaedic surgeons (68.6%). Panelists were more likely to reach consensus on nonoperative treatment for nondisplaced fractures without shortening early in the year and were more likely to avoid nonoperative treatment for displaced fractures with shortening. Conclusion: The current study group considers multiple clinical factors in determining optimal treatment for collegiate football players with clavicular fractures, incorporates adjuncts to traditional management, and identified a limited set of scenarios that achieved consensus.