title: Return to Sport After Tibial Shaft Fractures: A Systematic Review.
abstract: BACKGROUND
  Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods.
  
  
  OBJECTIVE
  To determine the current evidence for the treatment of and return to sport after tibial shaft fractures.
  
  
  METHODS
  OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Scholar were all searched for articles published from 1988 to 2014.
  
  
  METHODS
  Inclusion criteria comprised studies of level 1 to 4 evidence, written in the English language, that reported on the management and outcome of tibial shaft fractures and included data on either return-to-sport rate or time. Studies that failed to report on sporting outcomes, those of level 5 evidence, and those in non-English language were excluded.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Level 4.
  
  
  METHODS
  The search used combinations of the terms tibial, tibia, acute, fracture, athletes, sports, nonoperative, conservative, operative, and return to sport. Two authors independently reviewed the selected articles and created separate data sets, which were subsequently combined for final analysis.
  
  
  RESULTS
  A total of 16 studies (10 retrospective, 3 prospective, 3 randomized controlled trials) were included (n = 889 patients). Seventy-six percent (672/889) of the patients were men, with a mean age of 27.7 years. Surgical management was assessed in 14 studies, and nonsurgical management was assessed in 8 studies. Return to sport ranged from 12 to 54 weeks after surgical intervention and from 28 to 182 weeks after nonsurgical management (mean difference, 69.5 weeks; 95% CI, -83.36 to -55.64; P < 0.01). Fractures treated surgically had a return-to-sport rate of 92%, whereas those treated nonsurgically had a return rate of 67% (risk ratio, 1.37; 95% CI, 1.20 to 1.57; P < 0.01).
  
  
  CONCLUSIONS
  The general principles are to undertake surgical management for displaced fractures and to attempt nonsurgical management for undisplaced fractures. Primary surgical intervention of undisplaced fractures, however, may result in higher return rates and shorter return times, though this exposes the patient to the risk of surgical complications, which include surgical site infection and compartment syndrome.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK greg_robertson@live.co.uk.
authors.forename: Greg A J
authors.initials: GA
authors.lastname: Robertson
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Wood
mesh_terms: D002370:Casts, Surgical; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications; D000068958:Return to Sport; D013978:Tibial Fractures / Q000601:surgery / Q000628:therapy*; D013997:Time Factors
keywords: fractures; outcome; shaft; sport; tibial; treatment