Kilkenny Conor J, Daly Gordon R, Whelehan Sean P, Vukanic Danilo, Alrawashdeh Maen, Boland Fiona, Quinlan John F, Molony Diarmuid C
Department of Orthopaedics, Tallaght University Hospital, Dublin, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
JSES Rev Rep Tech. 2024 Dec 14;5(2):259-269. doi: 10.1016/j.xrrt.2024.11.002. eCollection 2025 May.
Clavicular fractures are common injuries in athletes, constituting up to 10% of all sport-related fractures. The location and severity of these fractures influence treatment decisions, which can range from conservative to operative management. Concerns exist regarding complications and delayed return to play (RTP), particularly for displaced midshaft and lateral fractures. Despite numerous studies on RTP following clavicle fractures, there is a lack of recent systematic reviews presenting comprehensive data on RTP rates and influencing factors. This systematic review aims to provide an overview of RTP in athletes following clavicle fractures, including an examination of fracture type, location, and management strategies.
This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified 33 clinical studies through searches in PubMed, EMBASE, Cochrane, CINAHL, Web of Science, and Scopus databases. Two independent reviewers conducted study selection, data extraction, and quality assessment, with discrepancies resolved by a third reviewer. Studies reporting on RTP after clavicular fractures, published in English, were included.
The review included studies involving a total of 1087 patients, reflecting a range of fracture characteristics and patient demographics. Overall, the RTP rate was 91%, with 86% of athletes returning to the same level of play. Rates varied based on the fracture location, with medial fractures showing the highest RTP (100%) and lateral fractures the lowest (78%). Operative and nonoperative management demonstrated similar RTP rates (92% vs. 91%), but operatively managed patients had higher rates of RTP to the preinjury level (92% vs. 78%). The mean time to RTP was 3.1 months for operatively managed fractures and 3.9 months for those managed nonoperatively.
High rates of RTP are seen for athletes managed both operatively and nonoperatively following a clavicular fracture. Effective management of lateral clavicular fractures remains an ongoing challenge. Patients with high functional demands need careful consideration to optimise RTP outcomes. While operative management may offer superior RTP to the preinjury level, the decision should consider potential complications and patient preferences. Standardized reporting of RTP outcomes is essential for future research to facilitate comparison and optimize management strategies.
锁骨骨折是运动员常见的损伤，占所有与运动相关骨折的10%。这些骨折的位置和严重程度会影响治疗决策，治疗方式可从保守治疗到手术治疗。人们担心并发症和延迟恢复运动（RTP），尤其是对于移位的中段和外侧骨折。尽管有许多关于锁骨骨折后RTP的研究，但最近缺乏系统综述来提供关于RTP率和影响因素的全面数据。本系统综述旨在概述运动员锁骨骨折后的RTP情况，包括对骨折类型、位置和管理策略的研究。
本系统综述遵循系统评价和Meta分析的首选报告项目指南，通过在PubMed、EMBASE、Cochrane、CINAHL、科学引文索引和Scopus数据库中检索，确定了33项临床研究。两名独立的评审员进行研究选择、数据提取和质量评估，如有分歧由第三名评审员解决。纳入以英文发表的关于锁骨骨折后RTP的研究。
该综述纳入了涉及总共1087名患者的研究，反映了一系列骨折特征和患者人口统计学数据。总体而言，RTP率为91%，86%的运动员恢复到相同的运动水平。RTP率因骨折位置而异，内侧骨折的RTP率最高（100%），外侧骨折最低（78%）。手术治疗和非手术治疗的RTP率相似（92%对91%），但接受手术治疗的患者恢复到伤前水平的RTP率更高（92%对78%）。手术治疗骨折的平均RTP时间为3.1个月，非手术治疗的为3.9个月。
锁骨骨折后接受手术和非手术治疗的运动员RTP率都很高。有效治疗外侧锁骨骨折仍然是一个持续的挑战。对功能要求高的患者需要仔细考虑以优化RTP结果。虽然手术治疗可能使RTP达到优于伤前的水平，但决策应考虑潜在并发症和患者偏好。RTP结果的标准化报告对于未来研究促进比较和优化管理策略至关重要。
