Fractures in sport: Optimising their management and outcome

Abstract

Fractures in sport are a specialised cohort of fracture injuries, occurring in a high functioning population, in which the goals are rapid restoration of function and return to play with the minimal symptom profile possible. While the general principles of fracture management, namely accurate fracture reduction, appropriate immobilisation and timely rehabilitation, guide the treatment of these injuries, management of fractures in athletic populations can differ significantly from those in the general population, due to the need to facilitate a rapid return to high demand activities. However, despite fractures comprising up to 10% of all of sporting injuries, dedicated research into the management and outcome of sport-related fractures is limited. In order to assess the optimal methods of treating such injuries, and so allow optimisation of their outcome, the evidence for the management of each specific sport-related fracture type requires assessment and analysis. We present and review the current evidence directing management of fractures in athletes with an aim to promote valid innovative methods and optimise the outcome of such injuries. From this, key recommendations are provided for the management of the common fracture types seen in the athlete. Six case reports are also presented to illustrate the management planning and application of sport-focussed fracture management in the clinical setting.

Finger Injuries in Football and Rugby

“…43 Plate and screw fixation are preferred, facilitating return to play in 14 days compared to 36 days with K wires. 44 Lag screws provide excellent fixation for long spiral metacarpal fractures.…”

Management of Sport-Related Fractures: Operative Versus Non-Operative Management

“…Such examples include surgical management of undisplaced scaphoid waist fractures, undisplaced tibial shaft fractures and undisplaced 5 th metatarsal base fractures (9)(10)(11)(12)(13). These principles, however, are site-specific, with other undisplaced 'stable' fractures, such as those of the ankle, being better managed with orthotic immobilisation and early rehabilitation, (5,9). The literature guiding such principles remains limited, and further evidence is required in this field to optimise practice (9).…”

“…There is however a growing body of literature that promotes a tailored choice of fracture management based on the activity level of the patient (9)(10)(11)(12)(13). Athletic patients with undisplaced 'unstable' fractures may benefit from primary surgical management to avoid the deconditioning associated with cast management and to promote earlier return to sporting activities (9)(10)(11)(12)(13).…”

“…These principles, however, are site-specific, with other undisplaced 'stable' fractures, such as those of the ankle, being better managed with orthotic immobilisation and early rehabilitation, (5,9). The literature guiding such principles remains limited, and further evidence is required in this field to optimise practice (9). As young athletic patients often have good quality bone with significant potential for fracture healing, when managed either operatively or nonoperatively (14,15), clear guidelines should be available to direct optimal management on individual fracture types to allow rapid return to sport as possible with the lowest side effect profile.…”

“…Athletic patients with undisplaced 'unstable' fractures may benefit from primary surgical management to avoid the deconditioning associated with cast management and to promote earlier return to sporting activities (9)(10)(11)(12)(13). Such examples include surgical management of undisplaced scaphoid waist fractures, undisplaced tibial shaft fractures and undisplaced 5 th metatarsal base fractures (9)(10)(11)(12)(13). These principles, however, are site-specific, with other undisplaced 'stable' fractures, such as those of the ankle, being better managed with orthotic immobilisation and early rehabilitation, (5,9).…”