The FACTS study is the largest prospective, multicenter epidemiological cohort of adolescent diaphyseal clavicle fractures in the United States. It enrolled 545 patients aged 10-18 across 8 pediatric tertiary centers to characterize fracture patterns, mechanisms, and treatment decisions. The study was designed to establish a baseline for future comparative outcome analyses of operative versus nonoperative management.
When a completely displaced adolescent clavicle fracture lands on your clinic schedule, the shortening measurement you use matters as much as the threshold you apply.
In this cohort of 545 adolescents, the end-to-end technique averaged 21.9 mm — above the commonly cited 20 mm surgical cutoff. The cortex-to-corresponding cortex method (the truer measure of actual length loss) averaged only 12.4 mm in the same fractures. A patient who appears to cross the operative threshold on one measurement may not on the other.
This is an active area of controversy. Adult randomized trials suggest operative fixation reduces nonunion and malunion in displaced fractures, but evidence for functional benefit beyond 6 months is mixed — and no high-level pediatric-specific evidence has driven the adolescent operative trend. Rates of surgical fixation in adolescents have risen from roughly 1.6% historically to 21-26% today, extrapolated from adult data applied to a population with meaningfully different periosteal biology.
The FACTS cohort establishes the epidemiological foundation for this population and sets up future comparative outcome studies. Until those data are available, specify your measurement technique before applying any shortening threshold to an operative decision in an adolescent.
The FACTS study is the largest prospective, multicenter epidemiological cohort of adolescent diaphyseal clavicle fractures in the United States. It enrolled 545 patients aged 10-18 across 8 pediatric tertiary centers to characterize fracture patterns, mechanisms, and treatment decisions. The study was designed to establish a baseline for future comparative outcome analyses of operative versus nonoperative management.
When a completely displaced adolescent clavicle fracture lands on your clinic schedule, the shortening measurement you use matters as much as the threshold you apply.
In this cohort of 545 adolescents, the end-to-end technique averaged 21.9 mm — above the commonly cited 20 mm surgical cutoff. The cortex-to-corresponding cortex method (the truer measure of actual length loss) averaged only 12.4 mm in the same fractures. A patient who appears to cross the operative threshold on one measurement may not on the other.
This is an active area of controversy. Adult randomized trials suggest operative fixation reduces nonunion and malunion in displaced fractures, but evidence for functional benefit beyond 6 months is mixed — and no high-level pediatric-specific evidence has driven the adolescent operative trend. Rates of surgical fixation in adolescents have risen from roughly 1.6% historically to 21-26% today, extrapolated from adult data applied to a population with meaningfully different periosteal biology.
The FACTS cohort establishes the epidemiological foundation for this population and sets up future comparative outcome studies. Until those data are available, specify your measurement technique before applying any shortening threshold to an operative decision in an adolescent.