Sports-Related Clavicle Injuries

Abstract

Clavicle fractures account for 4–6% of all fractures, and the majority of these occur in the midshaft [1, 2]. Much like the general population, clavicle fractures in athletes have traditionally been treated with nonoperative methods. The main impetus for this approach has been the overall good outcomes and minimal complications afforded with nonoperative treatment. At our institution we treat these with plate fixation, but use of intramedullary nailing has also been reported with similar outcomes [1, 3]. Clavicular malunion has been described as being primarily a radiographic phenomenon, and midshaft clavicle fractures “generally did well with non-operative care.” [2] Surgical fixation of clavicle fractures has traditionally been reserved for open fractures, skin tenting, floating shoulder, and cases of symptomatic nonunion. However, more recent literature suggests that operative fixation of these injuries may be superior to nonoperative treatment with lower nonunion and malunion rates, improved patient satisfaction, better functional outcomes, and improved cosmesis [4–8]. Hill et al. [5] found a 15% nonunion rate, and 31% of patients reporting unsatisfactory results in 52 displaced fractures that were treated nonoperatively. Shortening of greater than 18–20 mm has also been shown to be associated with unsatisfactory results [5, 9].