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

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.

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

Cohort study; Level of evidence, 3.

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.

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.

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.