Displaced Clavicle Fractures in Cyclists: Return to Athletic Activity After Anteroinferior Plate Fixation

Ven, Denise J.C. van der; Timmers, Tim K.; Broeders, Ivo A. M. J.; Olden, G.D.J. van

doi:10.1097/jsm.0000000000000552

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…32 Several studies have reported excellent clinical outcomes, high patient satisfaction, low nonunion rates (0%-5%), and very high rates of both return to sport (98%-100%) and return to prior level of play (94%-100%) after early rigid fixation of displaced midshaft clavicle fractures with mean return-to-sport time ranging from 45 to 83 days depending on the study. 24,26,31,32,38,42 Excellent outcomes and high return to sport have been reported in elite cyclists 40 and NFL football players. 18…”

Section: Discussionmentioning

confidence: 95%

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Ziegler¹,

Aman

Storaci

et al. 2019

Am J Sports Med

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Background: Limited biomechanical data exist for dual small plate fixation of midshaft clavicle fractures, and no prior study has concurrently compared dual small plating to larger superior or anteroinferior single plate and screw constructs. Purpose: To biomechanically compare dual small orthogonal plating, superior plating, and anteroinferior plating of midshaft clavicle fractures by use of a cadaveric model. Study Design: Descriptive laboratory study. Methods: The study used 18 cadaveric clavicle specimens (9 pairs total), and 3 plating techniques were studied: anteroinferior, superior, and dual. The dual plating technique used smaller diameter plates and screws (1.6-mm thickness) than the other, single plate techniques (3.3-mm thickness). Each of the 9 clavicle pairs was randomly assigned a combination of 2 plating techniques, and randomization was used to determine which techniques were used for the right and left specimens. Clavicles were plated and then osteotomized to create an inferior butterfly fracture model, which was then fixed with a single interfragmentary screw. Clavicle specimens were then potted for mechanical testing. Initial bending, axial, and torsional stiffness of each construct was determined through use of a randomized nondestructive cyclic testing protocol followed by load to failure. Results: No significant differences were found in cyclical axial ( P = .667) or torsional ( P = .526) stiffness between plating groups. Anteroinferior plating demonstrated significantly higher cyclical bending stiffness than superior plating ( P = .005). No significant difference was found in bending stiffness between dual plating and either anteroinferior ( P = .129) or superior plating ( P = .067). No significant difference was noted in load to failure among plating methods ( P = .353). Conclusion: Dual plating with a smaller plate-screw construct is biomechanically similar to superior and anteroinferior single plate fixation that uses larger plate-screw constructs. No significant differences were found between dual plating and either superior or anteroinferior single plating in axial, bending, or torsional stiffness or in bending load to failure. Dual small plating is a viable option for fixing midshaft clavicle fractures and may be a useful low-profile technique that avoids a larger and more prominent plate-screw construct. Clinical Relevance: Plate prominence and hardware irritation are commonly reported complaints and reasons for revision surgery after plate fixation of midshaft clavicle fractures. Dual small plate fixation has been used to improve cosmetic acceptability, minimize hardware irritation, and decrease reoperation rate. Biomechanically, dual small plate fixation performed similarly to larger single plate fixation in this cadaveric model of butterfly fracture.

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Section: Discussionmentioning

confidence: 95%

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Ziegler¹,

Aman

Storaci

et al. 2019

Am J Sports Med

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“…Van Der Ven and colleagues found that professional cyclists returned to athletic activity 10 days postoperatively with good functional outcomes observed. 11 Conversely, the work of Jack and colleagues found that the average time lost postsurgery in professional American footballers was 211.3 days. 12 Both studies reported high levels of return to sport, which was again observed in our work.…”

Section: Discussionmentioning

confidence: 99%

“…This may indicate a role for earlier return to racing in professional jockeys similar to that reported by Van Der Ven and colleagues, which is an interesting area for future research. 11…”

Section: Discussionmentioning

confidence: 99%

“…Although the complication rate in our cohort was relatively low and was consistent with the research observed in other athletic populations, operative fixation of the clavicle is not without risk. 8,11 Leroux and colleagues 14 reported that 24.6% of patients undergoing ORIF for midshaft clavicular fracture in their cohort (n = 1350) required at least one subsequent operation. Most commonly, patients required metalwork removal (18.8%) owing to prominence or soft tissue irritation, with the risk being higher in women than men.…”

Section: Discussionmentioning

confidence: 99%

“…8 Similarly Van Der Ven noted that patients had excellent functional outcomes at 24 weeks postoperatively, with a mean QuickDASH score of 2.9 ± 4.6. 11…”

Section: Discussionmentioning

confidence: 99%

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Return to Sport After Operative Fixation of Midshaft Clavicle Fractures in Professional Jockeys

Fahy

Doinn²,

Peters

et al. 2023

Clinical Journal of Sport Medicine

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Objective: Clavicle fractures are the most commonly observed fracture sustained in professional horse racing. This study is the first to report on time lost from injury and functional recovery after surgical fixation of midshaft clavicle fractures in professional jockeys. Design: Retrospective cohort study. Setting: Professional Horse Racing Ireland; Patients (or Participants): Professional Jockeys in Ireland with midshaft clavicular fractures managed with Open Reduction Internal Fixation. Interventions (or Assessment of Risk Factors or Independent Variables): Operative fixation with Open Reduction Internal Fixation. Main Outcome Measures: Assessment of postoperative Quick Disabilities of Arm Shoulder and Hand (QuickDASH) score and Patient Reported Outcome Measures assessing for associated complications and time to return to competition among professional athletes. Results:Between 07/06/2013 and 29/09/2022, 22 patients met the predetermined inclusion criteria. Ninety-five percent of patients returned to competition at their preinjury level, one patient failed to return to competition for reasons unrelated to his injury. The mean time for return to competition was 68.14 days postinjury. Few complications were reported, whereas functional recovery was excellent across the cohort, with an average QuickDASH score of 0.85 (0.0-2.3). Conclusions: Plate fixation of midshaft clavicle fractures is effective and safe in the setting of professional horse racing. Ninety-five percent of patients can be expected to return within 14 weeks of injury. Patients returning at less than 7 weeks after injury had no adverse outcomes, suggesting a potential role for more aggressive rehabilitation postoperatively and ultimately, a quicker return to competition.

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Cycling (BMX, Mountain, Road, Track)

Komnos

Ménétrey

2021

Specific Sports-Related Injuries

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Displaced Clavicle Fractures in Cyclists: Return to Athletic Activity After Anteroinferior Plate Fixation

Abstract: Plate fixation for cyclists with displaced clavicle fractures was successful in terms of fast return to previous level of athletic activity. It is a valuable and safe option for athletes in cycling.

Cited by 11 publications

References 22 publications

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Return to Sport After Operative Fixation of Midshaft Clavicle Fractures in Professional Jockeys

Cycling (BMX, Mountain, Road, Track)

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