Return to play following clavicular fracture – a systematic review and meta analysis

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Level of evidence: Level III Systematic Review- Meta-Analysis