 Whether surgical or non-surgical treatment is better for individuals with completely displaced mid-shaft clavicle fractures is controversial. There is particularly little evidence for adolescents, despite the fact that they're the most commonly affected population. According to a new study, surgery is not superior to non-operative treatment for restoring function and preventing complications in this patient group, and may instead pose greater risks for this young population. The findings are published in the American Journal of Sports Medicine. In completely displaced mid-shaft clavicle fractures, also called displaced diafacial fractures, the clavicle breaks near the midpoint, and the broken ends shift out of alignment. While immobilization with a simple shoulder sling is the traditional mode of treatment, surgical treatment has become more common. However, it's unclear whether findings on outcomes in adults can be translated to adolescent patients, whose clavicles are still growing and may heal differently. In the new study, researchers screened adolescents at eight pediatric centers who underwent either surgery or non-surgical treatment for completely displaced mid-shaft clavicle fractures. Radiographic and clinical data, complications, and patient-reported outcomes were recorded for two years. Overall, data were obtained from 282 patients. There was no difference in sex or athletic participation between the surgical and non-surgical groups, but the patients in the surgical group tended to be older, and they had a greater incidence of communuted fractures and greater fracture shortening. The patient-reported outcomes at two years did not differ between the groups. However, patients who underwent surgical treatment had more significant complications and unexpected subsequent surgeries, most commonly removal of clavicle implants. The rates of non-union, delayed union, symptomatic malunion, and refraction were very low for both groups and didn't differ between the groups. Notably, while most patients were followed through the period of fracture healing and returned to sports, six-month and one-year follow-up data were not consistently collected. Two-year follow-up rates were lower than expected, although functional outcomes were collected in over two-thirds of patients with no detected differences between patients who did and patients who did not complete surveys. Some functional outcomes may have been missed because of the relatively short study duration. In addition, despite statistical adjustment for confounding factors in the analysis, the bias toward older patients and more severe fractures in the surgical group may have skewed the results. Finally, the treatment methods were not standardized across patients. Despite these limitations, the study provides evidence that surgical treatment does not promote better outcomes than non-surgical treatment in adolescents with completely displaced mid-shaft clavicle fractures. Rather, it may introduce more risk. Non-surgical treatment produces comparable functional outcomes in these patients while reducing the risk of complications and subsequent unexpected surgeries.