colleagues for being willing to study clavicle fractures for seven years. And you get the record for the most number of co-authors. I appreciate that. Thank you. I have no relevant disclosures. Is there a quicker way here? What am I doing wrong? Try to get... There we go. So adolescent clavicle fractures, as we know, are a common injury with 80% of these occurring in the middle third of the bone. They're twice as common in adolescents than in any other age group, and the most common mechanism is sports. Starting in 2005 with Dr. McKee's early work, we started to see a significant increase in literature suggesting that in adults, clavicle fractures may benefit from surgical stabilization. As a result, we've seen a similar upward trend in the adolescent population in spite of a lack of evidence. But equipoise remains as to who might be the best candidate. Our pediatric meeting in 2019, the FACT study group presented our initial cohort that looked at operative versus non-operative management of displaced fractures and found that the non-operative treatment arm had lower complications, similar satisfaction, and similar functional outcomes. But several treatment questions remain. So who are the best candidates for surgery? Does surgery allow for earlier return to sport? Do our older adolescents have a higher non-union rate than their younger counterparts? And do patients most dependent on biomechanics report higher functional outcomes with surgery? The hypothesis of this study is that the operatively treated clavicle fractures with the most severe patterns in an athletic population would have superior outcomes to those managed non-operatively. We looked at our initial cohort that was collected from 2013 to 18 across eight geographically diverse centers, and we pulled out the cohort ages 14 to 18 with an either comminuted fracture or shortening greater than 25 millimeters. Each of these patients also participated in sports. These patients had all been enrolled prospectively across our eight centers. The treatment decision and follow-up schedule was ultimately at the discretion of the treating provider with recommended follow-up schedules at two, six, and 12 weeks, and standard radiographs were obtained. Routine data collection was performed, and patient-reported outcomes were collected at six, 12, and 24 months with a battery of PROs. So this left us with 137 patients equally divided between the non-operative and operative groups. There was no difference in age, sex, hand dominance, fracture shortening, or fracture comminution. There's a slight increase in superior displacement in the operative group. When we looked at sports participation, they were distributed equally across both groups with football being the most common sport in both groups, and approximately 80% of both groups identified as being a competitive athlete. When we looked at our primary outcomes, we had no difference in nonunion, delayed union, symptomatic malunion, refracture, or clinically significant complications, and even after we subtracted sensory deficits from the operative group, we saw no difference. When we looked at our patient-reported outcomes, we had 100 patients complete two-year data, again, evenly divided between the groups with mean values and dichotomized PRO scores showing no difference even with regression analysis. When we looked at return to sport, we did see a time to return to sport at 3.1 weeks faster in the operative group, but at two years, there was no difference detected between final reported return to sport or level of performance. So in conclusion, this is a prospective multicenter study. We looked at comminuted or severely shortened fractures as defined by greater than 25 millimeters, and only at the mid-shaft clavicle population. This was in older adolescents who identified as being an athlete, and in that group, there was no difference in complications, patient-reported outcomes, or rate or level of return to sport in either group. There was a time of return to sport 3.1 weeks faster in the surgical arm. Thank you.

adolescent clavicle fractures

surgical stabilization

FACT study group

non-operative group

operative group