NFL study to find best management of middle third clavicle fractures

Small study size but interesting article on outcome from conservative and surgical repair of the middle third clavicle fractures take a look at the abstract

Evolving Management of Middle-Third Clavicle Fractures in the National Football League

1. Robert J. Morgan, MD*†,
2. Larry S. Bankston Jr, MD‡,
3. Michael P. Hoenig, MD§ and
4. Patrick M. Connor, MD‖

+Author Affiliations

1. ^†Resurgens Orthopaedics, Atlanta, Georgia
2. ^‡Baton Rouge Orthopaedic Clinic, Baton Rouge, Louisiana
3. ^§Orthopaedics Associates, Spartanburg, South Carolina
4. ^‖OrthoCarolina, Charlotte, North Carolina

1. *Robert J. Morgan, MD, 3211 Iris Drive, Covington, GA 30016 (e-mail:morganrj@resurgens.com).

Abstract

Background: Clavicle fractures have historically been managed nonoperatively. Recent literature suggests a subset of clavicle fractures may be best treated with primary surgical treatment.

Purpose: To review the National Football League (NFL) experience in the management of middle-third clavicle fractures over a 5-year period.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective review of clavicle fractures that occurred during a 5-season period was obtained from the NFL Injury Surveillance System. A detailed questionnaire was also sent to the medical staff of all 32 NFL teams.

Results: Nineteen players sustained a middle-third clavicle fracture over the 5-year period. Six fractures were nondisplaced or minimally displaced. All 6 healed at an average time of 7.3 weeks. Thirteen fractures were 100% displaced. Six of the 13 underwent acute surgical fixation that resulted in fracture healing without complication at an average of 8.8 weeks. The remaining 7 players with a completely displaced fracture were initially treated nonoperatively. Three of these 7 healed clinically without sequela at an average of 13.3 weeks after injury; however, 4 players sustained a refracture within 1 year of the initial injury.

Conclusion: Over the past 5 years, nearly 50% of NFL players with a completely displaced middle-third clavicle fracture were treated successfully with acute surgical fixation without sequela and healed at an average of 8.8 weeks. Three of these players were able to return to play during the same season. In addition, 4 of 7 players initially treated nonoperatively for a completely displaced middle-third clavicle fracture refractured their clavicle within a 1-year period from their initial injury. The 4 players missed an average of 1.5 seasons because of their clavicle injury and subsequent clinical course. Based on this review, it may be reasonable to consider acute surgical treatment of this injury in the NFL player to enable a successful clinical outcome in a predictable time frame.

Keywords:

• clavicle
• fracture
• management
• National Football League (NFL)

Study finds better early results with stretching vs. shockwave therapy for plantar fasciitis

Study finds better early results with stretching vs. shockwave therapy for plantar fasciitis.

File this under "Shocker" ......I have great success using Braces, orthotic, Graston Technique, laser therapy and of course stretching. I always find it strange how quick the patients are recommended this procedure. Take a look at the abstract.

J Bone Joint Surg Am. 2010 Nov;92(15):2514-22.

Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.

Rompe JD, Cacchio A, Weil L Jr, Furia JP, Haist J, Reiners V, Schmitz C, Maffulli N.

OrthoTrauma Evaluation Center, Oppenheimer Strasse 70, D-55130 Mainz, Germany. profrompe@web.de.

Abstract

BACKGROUND: Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously.

METHODS: One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first few steps of walking in the morning) on this index, and satisfaction with treatment.

RESULTS: No difference in mean age, sex, weight, or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with plantar fascia-specific stretching than for those managed with shock-wave therapy (p < p =" 0.002).">

CONCLUSIONS: A program of manual stretching exercises specific to the plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms of proximal plantar fasciopathy.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.+

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