Clinical Outcomes For Open Reduction Internal Fixation Of Midshaft Clavicle Fractures In Adolescent/post-adolescent Athletes Utilizing A Two Month Return To Play Protocol

Abstract

Objectives: The success rate and the return to sport after midshaft clavicle fracture has been shown to improve with open reduction internal fixation (ORIF) treatment versus non-operative management. The period of time for return to sport, post-ORIF, has been reported in the literature with considerable range. Return to sport times for NFL athletes are reported to typically require three to seven months, while professional cyclists have resumed training in only one week. As the percentage of clavicle fractures in athletes is likely dominated by the high school and college populations, it is clinically relevant to evaluate the success of specific return to sport protocols after clavicle ORIF with respect to age. To evaluate this aspect of care, a retrospective study utilizing an adolescent/immediate post-adolescent and an adult control patient was performed. Methods: A single surgeon performed locking plate ORIF of clavicle fractures with patient population of athletes, ages 13 to 22 years old (mean 16.7 yrs.), and an adult control group (mean 50.8 yrs.). A uniform period for return to sport of two months was utilized for the athlete group, unless complications were present. The athlete group contained 90 patients, and the adult control group contained 64 patients. The athlete group had 48% of fractures resulting from football. High energy mechanisms (auto accident, ATV accident, etc.) accounted for 23.3% of the athlete group fractures, while these mechanisms accounted for 46.9% of the adult group fractures. Post-operative complications and adverse outcomes were monitored for a minimum period of one year. Results: Clavicle fractures within both patient groups were dominantly midshaft fractures with 97.7% of the athlete fractures and 88.5% of the adult fractures being located midshaft. The athlete group exhibited minimal post-operative complication/adverse outcomes with one patient reporting pain with weightlifting and two patients requiring minor scar revisions, for a total complication/adverse outcome rate of 3.3%. The adult group included ten patients with significant residual pain and one patient requiring revision for non-union, yielding a total complication/adverse outcome rate of 15.6% in this group. Applying a Chi-square analysis, a statistically significant difference in complication/adverse outcome rates exist between the patient groups (p=0.003). Additionally, all patients in the athlete group, desiring to return to their sport, did so within the two-month post-operative period. Conclusion: Locking plate ORIF of midshaft clavicle fractures allowed for a successful two month return to sport, with a low occurrence of complications, for a young athlete patient group. High energy fracture events and an adult aged patient group were associated with higher rates of adverse clinical outcome.