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Abstract
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BACKGROUND: There is a trend toward increased surgical treatment of displaced clavicle fractures in the adolescent population presumably due to extrapolation of adult-derived best practice guidelines. The purpose of this study was to compare return to sport between non-operative and operative treatment of clavicle fractures in high school athletes.
METHODS: A retrospective review of clavicle fractures sustained in scholastic athletes participating in school sponsored athletics in the Upstate of South Carolina was performed from 2015 to 2019. Injury circumstances, demographics, radiographs, treatment, and return to sport data was documented for all patients. Radiographs were evaluated for fracture location, comminution, displacement, shortening, and angulation. Patients were followed until complete return to sport, and Results were compared based on sport participation, injury mechanism, fracture morphology, treatment type, and time to return to sport.
RESULTS: Forty-seven patients (44 were male; average age 15.6 years old) were included who all returned to sport within the original or subsequent season. Thirty-six patients (73%) were managed conservatively (30 middle third fractures, 4 medial third fractures, 2 distal third fractures) while 11 were managed surgically (11 middle third fractures). Eighty-one percent of fractures occured in collision athletes (55% in football). There was no difference in time loss based on participating in collision versus non-contact sports (P=0.4). Conservatively managed fractures returned to sport faster (61 +/- 38 days vs. 100 +/- 49 days; p=0.008) compared to surgically managed patients. Fracture displacement ≥ 100% (100 +/- 51 days vs. 54 +/- 27 days; p=0.001), greater comminution (128 +/- 50 days vs. 59 +/-31 days; P=0.001) and angulation (86 ± 52 days vs. 54 ± 22 days; P=0.001) all were statistically significant for slower return to sport. Athletes presenting with clavicular shortening < 2cm returned to sport within a similar timeframe as athletes with ≥ 2cm (P=0.1).
CONCLUSION: Our Results show that adolescent athletes with clavicular fractures predictably return to athletics including collision sports. Athletes conservatively managed returned 40% faster than those with surgery. However, this appears to be associated with the severity and complexity of fractures treated surgically. This study provides evidence to counsel adolescent athletes following clavicular fractures on return to sport expectations.
Language: en |