New Studies Shed Light on Clavicle Fractures in NFL Players

In two new studies evaluating clavicle fracture treatments in National Football League (NFL) players, researchers at Houston Methodist Orthopedic and Sports Medicine in Texas found that treatment decisions are multifactorial and that it is important for physicians to educate patients on the risks and benefits of all treatment options.

In “Performance and Return-to-Sport After Clavicle Open Reduction and International Fixation in National Football League Players” published in the August issue of the Orthopaedic Journal of Sports Medicine, Joshua D. Harris, M.D., an orthopedic surgeon with Houston Methodist, and his team determined return-to-sport (RTS) rates in National Football League players after clavicle fracture open reduction and international fixation (ORIF), postoperative career length and games per season, pre- and postoperative performance and compared them to control players.

According to the data, 16 players with 17 surgeries were analyzed. Fifteen players (94.1%) returned to sport in the NFL at a mean 211.3 ± 144.7 days post-surgery. 7 or 44% returned within the same season. The overall rate for remaining in the NFL one year after surgery was 88.2%.

The researchers concluded that “there is a high rate of RTS in the NFL after clavicle fracture ORIF. Players who underwent clavicle fracture ORIF played in a similar number of games per season and had similar career lengths in the NFL as controls.”

They added, “Quarterbacks and running backs had significantly worse postoperative performance scores when compared with postindex matched controls.”

In “Performance and Return-to-Sport After Nonoperative Treatment of Clavicle Fractures in National Football League Players” published in the August 2017 issue of Orthopedics, Harris and his colleagues were looking instead at the return-to-sport rate of NFL players after nonoperative treatment of clavicle fractures. They also looked at posttreatment career length and games per season, pre-and posttreatment performance and posttreatment performance compared with control players.

Of the 30 players analyzed, 96.9% were able to return to sport as a mean of 244.4 ± 119.6 days. Eight of the players were able to return to the game the same season as their injury. The researchers found that while the players with nonoperative treatment have similar career length to controls (p > .05), wide receivers played fewer games per season (p = .043).

Harris told OTW, “For both athletes and non-athletes, treatment decisions regarding clavicle fractures are quite multifactorial. We treat patients, not X-rays. That being said, there are several radiographic features of clavicle fractures that predict significantly better outcomes if surgically treated. These include the magnitude of displacement, shortening, and comminution. Treatment is further dictated by the patient’s athletic goals, timing to return to sport (or employment), and overall health or lifestyle.

“Most importantly, it is the surgeon’s job to educate the patient on the risks, benefits, alternatives, and expected outcomes of each treatment option and the patient should decide which option fits best for them.”

He added, “Traditionally in the past, the vast majority of clavicle fractures were treated non-surgically. However, recent high level evidence has suggested superior outcomes with surgery. Thus, we chose to compare these two treatments in the NFL based on the evidence that already exists in the publicly available sources used in these two studies.”

“Specifically in the case with wide receivers, I wouldn’t say that wide receivers had ‘poorer’ results. We found a small difference in the amount of games per season a wide receiver played after injury compared to before injury. However, when we compared this injured wide receiver to an uninjured control wide receiver, there was no difference in number of games played per season. This illustrates the benefit of using a control group in a retrospective study such as this.”