An epidemiologic study of 535 isolated clavicle fractures treated in a hospital of a large metropolis during an 11-year period was performed. Data regarding patient's age and sex, side involved, mechanism of injury, and season in which the fracture occurred were obtained from the clinical records. Radiographic classification was performed with the Allman system. Clavicle fractures represented 2.6% of all fractures and 44% of those in the shoulder girdle. Most patients were men (68%), and the left side was involved in 61% of cases. Fractures of the middle third of the clavicle, which were the most common (81%), were displaced in 48% of cases and comminuted in 19%. Fractures of the medial third were the least common (2%). The prevalence of midclavicular fractures was found to decrease progressively with age, starting from the first decade of life when they represented 88.2% of all clavicle fractures and were undisplaced in 55.5% of cases. In adults, the incidence of displaced fractures, independent of location, was higher than that of undisplaced fractures. Traffic accidents were the most common cause of the injury. In the period under study, the incidence of fractures showed no significant change over time and no seasonal variation.

Clavicle fractures are a very common injury due to accidental trauma, specifically during athletics. The purpose of this study was (1) to determine the incidence of clavicle fractures presenting to United States emergency departments; (2) to compare the rate of clavicle injuries from 2012 to 2015 to 2002-2005 (3) to determine the most common mechanisms of injury for clavicle fractures.The National Electronic Injury Surveillance System (NEISS) was queried for the years --. Examined variables included patient age, sex, and year of admission. Total annual case numbers were estimated using NEISS hospital weights. Annual injury incidence rates by age group and patient sex were calculated based on yearly U.S. Census estimates. Chi square test and logistic regression were used to compare injury rates by sex and age groups. Statistical significance was set at P < 0.05.During the 8 years studied, the participating emergency departments (EDs) coded 14,795 fracture exposures. Using weighted estimates, this represent 545,663 injuries nationally (95% CL 425,986-665,339). This resulted in an incidence of 22.4 injuries per 100,000 person years (95% CL 17.5-27.3). The most common causes of injury were bicycles (15.1%), football (10.7%), beds/bedframes (6.8%), stairs (5.4%), and floors (4.0%). Fifty percent of clavicle fractures were due to an athletic activity. There was no significant change in injuries from 2002 to 2005 compared to 2012-2015 (23.1 per 100,000, 95% CL 18.5-27.7, and 22.4 per 100,000 person years (95% CL 17.5-27.3), respectively).Clavicle fractures continue to occur at similar rates, with athletics accounting for 50% of injuries. Patients most at risk for clavicle fracture was bimodal in nature, with males aged 0-19 being the most common. Females were most at risk between 0 and 9 years old.

Our goal was to present current data on the incidence of clavicle injuries presenting for urgent evaluation and to report the sports activities associated with injury. Using the National Electronic Injury Surveillance System (NEISS) database, the number of clavicle fractures presenting to a representative sample of U.S. hospitals was retrospectively calculated and weighted estimates used to extrapolate this data to the U.S. population. Incidence estimates were obtained using validated analyses and U.S. census data, with sports injuries being noted and fractures stratified by sport. A total of 9 428 fractures of the clavicle were reported, representing 357,155 injuries in the U.S. population over 5 years. The estimated incidence of clavicle fractures in the U.S. presenting for emergency care is 24.4 fractures per 100,000 person-years (95% confidence intervals (CI), 22.8-26.1). The peak incidence was highest between ages 10-19 years. Men were nearly 3 times as likely to sustain a clavicle fracture. Sports were a factor in 45% of all clavicle fractures. In sports-related injuries, 16% of fractures occurred from bicycling, followed by football (12%) and soccer (6%). In summary, injuries from bicycling were the most common cause of clavicle fracture, followed by contact sports. Male gender and younger age are risk factors for clavicle fractures.© Georg Thieme Verlag KG Stuttgart · New York.

Clavicle fractures are common injuries sustained by cyclists, but there is little evidence about return to competition times (RTCT) in elite cyclists. Our aim was to investigate this, and risk factors for delayed return.We identified elite cyclists who sustained clavicle fractures between 2015 and 2020. Freely available records were reviewed to validate data for RTCT. Secondary outcomes included return to outdoor cycling, management, time to surgery, cause of injury, other injuries, and ability to complete the event returned to.Records were reviewed of 1449 cyclists, identifying 188 clavicle fractures. 44 were recurrent fractures and were excluded. Those with isolated clavicle fractures (111; 92 male, 19 female) had a mean RTCT of 56.7 days, compared with 74.9 for those with multiple injuries (33) (p = 0.048). Those with multiple injuries were excluded from secondary outcome measures. All those with isolated injuries returned to elite competition. 83% were managed surgically with an RTCT of 53.8d, with no significant difference to those managed non-operatively, 59.3d (p = 0.61). RTCT was significantly lower for injuries sustained January-July (46.5d) than August-December (95.8d, p = 0.00). The incidence during Grand Tours was 0.06/1000 h for males (95% C.I 0.03-0.09), and 0.11/1000h (95% C.I 0.00-0.26) for females.This is the largest study evaluating return to sport in elite cyclists with clavicle fractures. Athletes with isolated clavicle fractures, able to return the same season, took an average 46.5 days to return to competition. Elite cyclists are at high risk of clavicle fractures and the majority are managed surgically. RTCT is longer than often expected by the media, and this data can help plan rehabilitation, and manage expectations in both professional and amateur cyclists.Level V.© 2022 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.

Intramedullary fixation of midclavicular fractures may be a better option than non-operative treatment for high performance/professional athletes because of the potential reduction in recovery time.To evaluate the effectiveness of intramedullary fixation in high performance athletes and the time required to return to sporting activity.Data were taken from a prospective study on intramedullary fixation techniques using the elastic stable Ti nail (TEN, Synthes) for the treatment of displaced midclavicular fractures, initiated in 1996. The patients in 12 cases were classified as high performance/professional athletes. These cases were used to evaluate the technique specifically in this population. Fractures were classified according to the Orthopaedic Trauma Association (OTA) system. Patients were evaluated before and after surgery for shoulder function and subjective pain. After the operation, radiological assessments documented fracture healing, and clinical outcomes scores were obtained. Time required to return to training and competition was documented.All fractures were transverse or oblique. Mean (SD) shoulder abduction increased from 36.3 (8) degrees before surgery to 154.2 (17) degrees afterwards (p<0.001). Mean subjective pain score using a visual analogue scale (0-100) decreased from 71.7 (18) points before surgery to 19.2 (6) points (p<0.001) three days after. There were no complications. Hospital stay averaged 2.9 (1) days. Mean delay to resumption of training was 5.9 (1) days, and to resumption of competition it was 16.8 (5) days. The mean Constant clinical outcomes score one year after hardware removal was 98.3 (2) points.Intramedullary fixation of displaced midclavicular fracture was successful in terms of clinical outcome and rapid resumption of sporting activities. This treatment should be offered to athletes as an alternative to non-operative treatment.

This review aims to provide information on the return rates and return times to sport following clavicle fractures.A systematic search of Medline, EMBASE, CINAHAL, Cochrane, Web of Science, PEDro, SPORTDiscus, Scopus and Google Scholar was performed using the keywords 'clavicle', 'clavicular', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative', 'return to sport'.Twenty-three studies were included: 10 reported on mid-shaft fractures, 14 on lateral fractures. The management principles for athletic patients were to attempt non-operative management for undisplaced fractures to undertake operative intervention for displaced lateral fractures and to recommend operative intervention for displaced mid-shaft fractures.The optimal surgical modality for mid-shaft and lateral clavicle fractures.Operative management of displaced mid-shaft fractures offers improved return rates and times to sport compared to non-operative management. Suture fixation and non-acromio-clavicular joint (ACJ)-spanning plate fixation of displaced lateral fractures show promising results.Future prospective studies should aim to establish the optimal treatment modalities for clavicle fractures.© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pain intensity is frequently measured on an 11-point pain intensity numerical rating scale (PI-NRS), where 0=no pain and 10=worst possible pain. However, it is difficult to interpret the clinical importance of changes from baseline on this scale (such as a 1- or 2-point change). To date, there are no data driven estimates for clinically important differences in pain intensity scales used for chronic pain studies. We have estimated a clinically important difference on this scale by relating it to global assessments of change in multiple studies of chronic pain. Data on 2724 subjects from 10 recently completed placebo-controlled clinical trials of pregabalin in diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and osteoarthritis were used. The studies had similar designs and measurement instruments, including the PI-NRS, collected in a daily diary, and the standard seven-point patient global impression of change (PGIC), collected at the endpoint. The changes in the PI-NRS from baseline to the endpoint were compared to the PGIC for each subject. Categories of "much improved" and "very much improved" were used as determinants of a clinically important difference and the relationship to the PI-NRS was explored using graphs, box plots, and sensitivity/specificity analyses. A consistent relationship between the change in PI-NRS and the PGIC was demonstrated regardless of study, disease type, age, sex, study result, or treatment group. On average, a reduction of approximately two points or a reduction of approximately 30% in the PI-NRS represented a clinically important difference. The relationship between percent change and the PGIC was also consistent regardless of baseline pain, while higher baseline scores required larger raw changes to represent a clinically important difference. The application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies. Use of a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies.

The Tampa Scale of Kinesiophobia (TSK) is a commonly-used measure for the assessment of fear of movement beliefs in chronic complaints, but its responsiveness in subjects after lumbar fusion has been never reported.Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion.Population-based cohort study.Secondary care rehabilitation hospital.In-patients undergoing rehabilitation after lumbar fusion.At the beginning and end of a four-week motor and cognitive-behavioral rehabilitation program, 180 patients completed the TSK. After the intervention, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the TSK and its subscales were calculated by distribution (effect size [ES], standardized response mean [SRM]) and anchor-based methods (receiver operating characteristics (ROC) curves; correlations between change scores of the TSK and its subscales and GPE). ROC curves were also used to compute MCID values.The ES ranged from 1.63 to 1.77 and the SRM from 1.25 to 1.39 for TSK and its subscales. The ROC analyses revealed a value of area under the curve (0.999 [95% CI: 0.978; 1.000], 0.998 [95% CI: 0.975; 1.000], 0.990 [95% CI: 0.962; 0.999] for the TSK, Harm and Activity Avoidance subscales, respectively). MCID values greater than 6 (95% CI: >5; >6), 4 (95% CI: >3; >5), and 2 (95% CI: >2; >2) were achieved for the TSK, Harm and Activity Avoidance subscales, respectively. Correlations between change scores of the TSK and its subscales and GPE were high (0.786-0.830).The TSK and its subscales were sensitive in detecting clinical changes in subjects undergoing rehabilitation after lumbar fusion.The obtained MCID values will help in the design of future randomized controlled trials and in the interpretation of the clinical impact of a rehabilitation program after lumbar fusion.

A national analysis of clavicle fractures is lacking and the risk of concomitant axillosubclavian vessel injury (ASVI) in patients with clavicle fractures is unknown. A minority of patients may have a combined brachial plexus injury (BPI). We sought to describe risk factors for concomitant ASVI in patients with a clavicle fracture; hypothesizing patients with combined clavicle fracture and BPI has a higher risk of ASVI.The Trauma Quality Improvement Program (2010-2016) was queried for blunt trauma patients with a clavicle fracture. A multivariable logistic regression model was used to determine risk factors for ASVI. A subset analysis on patients with isolated clavicle fractures was additionally performed.From 59 198 patients with clavicle fractures, 341 (.6%) had concomitant ASVI. Compared to patients without ASVI, patients with ASVI had a higher median injury severity score (24 vs. 17, <.001) and rates of pulmonary contusions (43.4% vs. 37.7%, =.029) and BPI (18.2% vs..4%, <.001). After controlling for associated chest wall injuries and humerus fracture, the BPI odds ratio (OR 49.17, 35.59-67.92, <.001) was independently associated with risk for ASVI. In a subset analysis of isolated clavicle fractures, BPI remained associated with risk of ASVI (OR 60.01, confidence intervals 25.29-142.39, <.001).The rate of concomitant ASVI in patients with a clavicle fracture is <1%. Patients presenting with a clavicle fracture had a high rate of injuries including pulmonary contusion. Patients with findings suggestive of underlying BPI had a nearly 50 times increased associated risk of ASVI. Thus, a detailed physical exam in this setting including brachial-brachial index appears warranted.

This chapter provides an overview of the prevalence of clavicle fractures in athletes. The evaluation and management of clavicle fractures in athletes is summarized, including surgical considerations, rehabilitation protocols, and return to sport guidelines. In this population, high rates of union are observed, but careful timing of return to sport is paramount to optimize performance and prevent reinjury.Copyright © 2023 Elsevier Inc. All rights reserved.