Clavicular Fractures in Sports
Most Common Shoulder Fracture
Fractures of the clavicle are common in all ages, but are most common in children and young adults (less than 25 years of age). While the most common mechanism of injury is a forceful fall with the arm at the side, the clavicle can also be fractured by a fall on the point of the shoulder, a direct blow to the clavicle either by an opponent or by an object, or by a fall on an outstretched arm.
Common sports in which clavicular fractures are seen include football, martial arts, lacrosse, gymnastics, ice hockey, wrestling, bicycling, and baseball.
Classification of Clavicular Fractures
Clavicular fractures are classified by their location (American Family Physician, January, 2008):
Group 1 – fractures on the middle third of the clavicle
Group 2 – fractures on the distal third portion of the clavicle
Group 3 – fractures on the medial third portion of the clavicle
According to Anderson, M.K., Parr, G.P., & Hall, S.J. (2009), close to 80% of traumatic fractures occur in the middle third of the clavicle. The middle third of the clavicle is vulnerable to fracture because the shape of the bone changes from a more circular design to a flatter shape in preparation for articulation with the acromion process of the scapula (acromioclavicular joint).
Signs and Symptoms
The signs and symptoms of a clavicular fracture include:
- Swelling
- Discoloration
- Deformity
- Pain with shoulder movement
- Pain on palpation
Because of the pain with shoulder movement, the athlete tends to guard the shoulder area by keeping the arm tucked in close to the body. Immediate treatment of the athlete should include a triangular bandage or sling (immobilize the shoulder), an ace bandage wrapped around the arm and trunk (to limit any additional movement), and an ice pack (to decrease swelling). The athlete should then be transported to the nearest medical facility.
Although most clavicular fractures are managed non-operatively with a sling or figure-eight brace for four to six weeks, there are recent research studies that report that displaced mid-shaft fractures heal better and with improved functional ability if surgically repaired.
New Research on Operative Management of Displaced Mid-shaft Fractures
Pujalte, G.G. and Housner, J.A. (2008) reported in the Journal of Current Sports Medicine Reports that recent studies demonstrated that surgically repairing a displaced midshaft fracture with a plate fixation resulted in better functional outcomes and a lower rate of malunion (when the ends of the bone fragments do not line up and heal together correctly).
Using a patient-based outcome questionnaire and an objective measure of strength (Baltimore Therapeutic Equipment Work Simulator), Dr. McKee and colleagues tested 30 patients who had been treated non-operatively for displaced mid-shaft clavicular fractures (Journal of Bone and Joint Surgery, January 2006). These patients were tested on their range of motion, strength, and endurance for both the injured and non-injured shoulders at an average length of 55 months post-injury.
Their results reported significant deficits in muscular strength and muscular endurance of the injured shoulder as compared to the non-injured shoulder:
- Reduction in strength (81%) and endurance (75%) for shoulder flexion
- Reduction in strength (82%) and endurance (67%) for shoulder abduction
- Reduction in strength (81%) and endurance (82%) for external rotation
- Reduction in strength (85%) and endurance (78%) for internal rotation
These studies indicate that a surgical approach to displaced mid-clavicular fractures may have a better outcome for the patient with less functional problems and better union between the bone fragments. This is especially important when a patient is an athlete whose goal is to return to full sports participation.
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