title: Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes.
abstract: BACKGROUND
  Recent prospective randomized trials support primary plate fixation of displaced midshaft clavicle fractures. However, the safety and efficacy of this practice have not been well documented in athletes, nor has the time to return-to-sport.
  
  
  OBJECTIVE
  To analyze the time to return-to-sport, functional outcomes, and complications in a group of athletes with displaced midshaft clavicle fractures treated using precontoured locking plates.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A total of 54 athletes with displaced midshaft clavicle fractures were treated with plate fixation between November 1, 2008, and December 31, 2012. The mean follow-up time was 22.4 months. Patients completed a questionnaire focused on the time to return-to-sport and treatment course. Functional outcomes were assessed with the Constant score and short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union time, malunion, and nonunion.
  
  
  RESULTS
  Of the 54 patients, 53 returned to sports after open reduction and internal fixation of their fracture; 94% returned to the same level. The mean time to return-to-sport was 68 days (range, 5-180 days). Nine (16.6%) of the cases returned to sports before 6 weeks after surgery, 40 (74%) returned between 6 and 12 weeks, and 5 patients (9.2%) returned 12 weeks after surgery. The mean Constant score was 94.1 ± 5.2 (range, 78-100), and the mean QuickDASH score was 0.4 ± 4.7 (range, 0-7.1). The mean VAS pain score during follow-up was 0.29 ± 1.0 (range, 0-5). Three major complications occurred: 1 extrinsic compression of the subclavian vein, 1 nonunion, and 1 hardware loosening. Hardware removal was necessary in 5 patients (9.3%).
  
  
  CONCLUSIONS
  Plate fixation of displaced clavicle fractures in athletes is a safe procedure resulting in excellent functional outcomes, with an early return to the same level of sports in the majority of patients.
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Ranalletta
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina luciano.rossi@hospitalitaliano.org.ar.
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Rossi
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Nicolás S
authors.initials: NS
authors.lastname: Piuzzi
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Agustin
authors.initials: A
authors.lastname: Bertona
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Santiago L
authors.initials: SL
authors.lastname: Bongiovanni
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Gaston
authors.initials: G
authors.lastname: Maignon
mesh_terms: D000328:Adult; D056352:Athletes; D001860:Bone Plates / Q000009:adverse effects; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D008297:Male; D010147:Pain Measurement; D020127:Recovery of Function; D013177:Sports; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: athletes; clavicular fractures; plate fixation