Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017 - PubMed (original) (raw)

Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017

Meagan M McCarthy et al. Orthop J Sports Med. 2019.

Abstract

Background: Little is known about the epidemiology of clavicle fractures in United States (US) high school athletes. Sports participation among high school students has increased steadily, placing increased numbers at risk of sports-related injury.

Purpose: To describe the epidemiology of clavicle fractures among high school athletes, including injury rates by sex, sport, and type of play and trends in operative versus nonoperative treatment.

Study design: Descriptive epidemiology study.

Methods: The study data set included all athlete-exposure (AE) and clavicle fracture data collected from 2008-2009 through 2016-2017 from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study for students participating in boys' football, boys'/girls' soccer, boys'/girls' basketball, boys'/girls' volleyball, boys' wrestling, boys' baseball, girls' softball, girls' field hockey, boys' ice hockey, boys'/girls' lacrosse, boys'/girls' swimming and diving, boys'/girls' track and field, girls' gymnastics, girls' cheerleading, boys'/girls' tennis, and boys'/girls' cross-country.

Results: Overall, 567 clavicle fractures were reported during 31,520,765 AEs, an injury rate of 1.80 per 100,000 AEs. Injury rates varied by sport, with the highest rates in the boys' full-contact sports of ice hockey (5.27), lacrosse (5.26), football (4.98), and wrestling (2.21). Among girls' sports, the highest rates were in soccer (0.92), lacrosse (0.26), and basketball (0.25). In sex-comparable sports, injury rates were still significantly higher among boys (1.03) than girls (0.35) (rate ratio, 2.91; 95% CI, 1.97-4.30). Injury rates were significantly higher in competition (4.58) as compared with practice (0.87) (rate ratio, 5.27; 95% CI, 4.44-6.26). Most injuries were treated conservatively (82.7%) rather than operatively (17.3%). Time to return to sports varied, with a greater proportion of medical disqualifications among those treated operatively (40.0%) as compared with those treated conservatively (22.6%) (injury proportion ratio, 1.77; 95% CI, 1.31-2.39).

Conclusion: Although clavicle fracture rates are relatively low, they vary by sport, sex, and activity. Understanding such differences should drive more effective, targeted injury prevention efforts. Increased time loss from sports with surgical versus conservative treatment may have been influenced by factors including injury severity and its timing relative to the season's progress.

Keywords: clavicle; epidemiology; pediatric sports medicine; shoulder.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: The High School Reporting Information Online surveillance study was funded in part by the Centers for Disease Control and Prevention (grants R49/CE000674-01, R49/CE001172-01, and R49/CE002106-01) as well as research funding contributions of the National Federation of State High School Associations, National Operating Committee on Standards for Athletic Equipment , DonJoy Orthotics, and EyeBlack. E.C.M. has received educational support from Zimmer Biomet, Mitek, Smith & Nephew, and Stryker; consulting fees from Zimmer Biomet; and royalties from Zimmer Biomet. R.M.F. has received educational support from Arthrex, Smith & Nephew, and Medwest and research support from Arthrex. M.M.M. has received educational support from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.

Figure 1.

Trends in clavicle fracture rate over time. There was no significant change in injury rate over time for male (P = .79), female (P = .57), or total athletes (_P_= .71). AE, athlete-exposure.

Figure 2.

Figure 2.

Treatment method for clavicle fractures by sport.

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