Dr. Millett comments on advantages of surgery for NFL players with clavicle fractures

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Dr Millett comments on advantages of surgery for NFL players with clavicle fractures.

Study results showed a high return-to-sport rate in National Football League players following nonoperative or operative treatment of clavicle fractures.

“Clavicle fractures are so common in NFL athletes because of tackling and the contact that occurs,” Peter J. Millett, MD, MSc, told Orthopedics Today. “They are most common in cases where the athlete is tackled and the shoulder is then driven into the ground.”

In a study published in Orthopedics, investigators evaluated 30 NFL players who were nonoperatively treated for clavicle fractures. They found 96.9% of athletes returned to sport at a mean of 244.6 days and 27.6% returned within the same season as their injury. After treatment, wide receivers played fewer games throughout the season.

Despite the high return-to-sport rate with nonoperative treatment, Millett, an Orthopedics Today Editorial Board Member, said he favors surgical treatment of clavicle fractures in athletes.

“While nonoperative treatment is a viable option for the treatment of certain clavicle fractures, surgical treatment is the preferred strategy for displaced fractures, for highly comminuted fractures and for fractures that are shortened 15 mm or more,” Millett said. “We also discuss operative treatment in high-level athletes and laborers, as operative treatment frequently allows these patients to get back to sports or work much more quickly. For example, in certain instances where there was an important event, I have had some athletes back to competition in as little as 2 weeks.”

A study in Orthopaedic Journal of Sports Medicine addressed return to sport in 16 NFL players with clavicle fractures after open reduction and internal fixation (ORIF). Researchers found 94.1% of players returned to sport at 211.3 days, mean, and 44% of players returned to sport within the same season as the injury/fixation. After 1 year postoperatively, 88.2% of them remained in the NFL.

“The offensive skill positions represented the largest proportion of players who underwent clavicle fracture ORIF, with 13 (81.3%),” the researchers wrote. “We hypothesize that the increased incidence of clavicle fractures within these position groups is likely due to getting tackled and driven into the ground onto the shoulder. On the contrary, defensive players are typically doing the tackling and are better able to control their bodies to avoid direct impact …”

In Millett’s experience, athletes have a faster, more predictable return to play after ORIF. He said, “[Surgical] treatment using modern techniques with [ORIF] is resulting in faster recoveries and more predictable outcomes for our athletes, weekend warriors and everyday patients.” – by Monica Jaramillo

Full Article: Clavicle fracture treatment had little effect on return to sport in NFL players