- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Midshaft clavicle fractures in adolescents: indications for surgery and outcomes # Midshaft clavicle fractures in adolescents: indications for surgery and outcomes February 3, 2026 2 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Midshaft clavicle fractures in adolescents: indications for surgery and outcomes](https://ortopediaevolutiva.com/blog-images/frattura-clavicola-adolescente-chirurgia-vs-trattamento-conservativo-neutral-v1.webp) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • Most collarbone breaks heal well without surgery, even if they look bad. - • Surgery is usually for serious risks like open wounds or nerve issues. - • For other breaks, surgery might not always lead to better function or less pain. Diaphyseal clavicle fractures in adolescents often heal well without surgery, even when X-rays show significant displacement. In recent years, surgical fixation has become more frequent, partly by analogy with adult treatment, but pediatric data require a more cautious selection. [1–4] ## The Strongest Indications Open [fracture](https://ortopediaevolutiva.com/en/conditions/injuries-fractures), neurovascular compromise, and a real threat to the skin are situations where surgical indication is strong. Some complex shoulder girdle injuries and polytrauma may also require stabilization. [3][4] Simple *skin tenting* must be distinguished from true skin compromise. In the 2025 FACTS cohort, among 88 adolescents with completely displaced fractures and tenting, about one-third were initially treated non-surgically, and none developed skin complications; 10% then underwent early fixation. [5] ## Severely Displaced Fractures Complete displacement, shortening, and comminution make surgical discussion understandable, especially in adolescents close to skeletal maturity. However, these alone do not constitute an absolute indication. The multicenter prospective FACTS data have scaled back the idea that surgical fixation systematically improves patient-reported outcomes compared to conservative treatment. [1] Surgery realigns the clavicle and can make the course more predictable in selected cases, but it introduces specific risks: plate irritation, wound problems, altered skin sensation, and possible second surgery to remove the hardware. [1–3] ## Sports and Skeletal Maturity For adolescent athletes, the type of sport, competitive level, season, and skeletal maturity are important. An adolescent nearing the end of growth has less remodeling potential than a younger child. However, surgery does not guarantee a faster return to sport in every case. This aspect should be discussed without turning competitive demands into an automatic indication. [2][4] ## When Conservative Treatment Remains Appropriate In the absence of absolute indications, with intact skin, normal neurovascular function, and manageable pain, non-surgical treatment remains appropriate for many even severely displaced fractures. [1–3] Follow-up serves to monitor pain, function, and skin condition, and to ensure that the recovery path remains consistent with initial expectations. ## How I Discuss the Choice In borderline situations, I consider fracture morphology, biological age, functional demands, surgical risk, and family preferences together. The X-ray is part of the decision, but does not replace it. Disclaimer Informational content; does not replace an individual clinical evaluation. ## References [1] Heyworth BE, et al. Prospective multicenter (FACTS): operative vs nonoperative in adolescent midshaft clavicle fractures. PubMed: [https://pubmed.ncbi.nlm.nih.gov/35984091/](https://pubmed.ncbi.nlm.nih.gov/35984091/) [2] Patel M, et al. Clavicular Fractures in the Adolescent. JBJS. 2023. PubMed: [https://pubmed.ncbi.nlm.nih.gov/36753567/](https://pubmed.ncbi.nlm.nih.gov/36753567/) [3] Markes AR, et al. Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents. Open access: [https://pmc.ncbi.nlm.nih.gov/articles/PMC9636878/](https://pmc.ncbi.nlm.nih.gov/articles/PMC9636878/) [4] Fanter NJ, et al. Surgical Treatment of Clavicle Fractures in the Adolescent Athlete. Open access: [https://pmc.ncbi.nlm.nih.gov/articles/PMC4332647/](https://pmc.ncbi.nlm.nih.gov/articles/PMC4332647/) [5] **Completely Displaced Midshaft Clavicular Fractures with Skin Tenting in Adolescents: Results from the FACTS Multicenter Prospective Cohort Study.** *J Bone Joint Surg Am.* 2025. PMID: 40446020. PubMed: [https://pubmed.ncbi.nlm.nih.gov/40446020/](https://pubmed.ncbi.nlm.nih.gov/40446020/) [6] Abbas AM, Abzug JM, Dunham AM, Stepanovich M, Ruzzi S, Herman MJ. **Pediatric and Adolescent Clavicle Fractures: To Fix or Not to Fix?** *Instr Course Lect.* 2026;75:571-576. PMID: 41289478. PubMed: [https://pubmed.ncbi.nlm.nih.gov/41289478/](https://pubmed.ncbi.nlm.nih.gov/41289478/) ## Complete injuries and fractures pathway This page is part of the paediatric injuries and fractures pathway. The main guide covers the overall picture and the warning signs. - [1 Overview: when an injury is urgent How growing bone behaves, what happens in the emergency room and when an orthopaedic review is useful.](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) - [2 Shoulder and arm Clavicle and humerus fractures: often managed without surgery, but the indication depends on age, site and displacement.](https://ortopediaevolutiva.com/en/conditions/clavicle-fracture-children) [Humerus](https://ortopediaevolutiva.com/en/conditions/humerus-fracture-children) - [Humerus surgery](https://ortopediaevolutiva.com/en/surgery/fractures/humerus) - [3 Elbow and forearm Supracondylar, forearm and wrist fractures: the most frequent paediatric sites.](https://ortopediaevolutiva.com/en/conditions/elbow-fracture-children) - [4 Hand and fingers: recovery after immobilisation Recovery sheet for finger motion after a splint or cast, with the stiffness signs to report.](https://ortopediaevolutiva.com/en/parents-kids/exercises/post-cast/after-finger-cast) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) ### Related Surgery Pages [Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ### Related Articles [Kirschner Wire Infection in Children: When Can It Become Osteomyelitis? Read](https://ortopediaevolutiva.com/en/blog/kirschner-wire-infection-children-osteomyelitis-risk)[Proximal humerus fracture in children: when is surgery really needed? Read](https://ortopediaevolutiva.com/en/blog/proximal-humerus-fracture-children-when-surgery-is-needed)[Growth plate fractures: why does follow-up continue after the bone has healed? Read](https://ortopediaevolutiva.com/en/blog/growth-plate-fractures-follow-up-after-healing) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/clavicle-fractures-in-adolescents-surgery-or-not Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.