RESUMEN
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.
Asunto(s)
Clavícula/lesiones , Fútbol Americano/lesiones , Fracturas Óseas/terapia , Adulto , Traumatismos en Atletas , Placas Óseas , Clavícula/cirugía , Fracturas Óseas/clasificación , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/epidemiología , Humanos , Masculino , Vigilancia de la Población , Radiografía , Estudios Retrospectivos , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Cicatrización de Heridas , Adulto JovenRESUMEN
BACKGROUND: Reverse shoulder arthroplasty has become more prevalent for the treatment of complex shoulder issues. Prosthetic designs vary in both the number and orientation of screws recommended for securing the glenoid base plate. This study examined the contribution of the posterior glenoid screw for stabilizing the glenosphere by comparing constructs with no posterior screw, a standard posterior screw directed into the glenoid neck, and a long posterior screw (LPS) into the scapular spine. MATERIAL AND METHODS: The Tornier RTSA glenoid implant was fixed into 2 groups of matched cadaveric scapulae. In both groups, the controls were fixed with a standard posterior screw (SPS). Matching scapulae had a screw configuration that omitted the posterior screw (NPS) in group I or utilized an LPS in group II. Specimens were tested using a "rocking-horse" protocol. During cyclic loading (50,000 cycles), the vertical displacement of the glenoid component was monitored using a digital caliper. RESULTS: In group I, NPS constructs demonstrated a significantly higher mean rate of loosening than SPS constructs. In group II, the LPS constructs demonstrated lower loosening rates than SPS constructs. Mean initial displacements were greater for NPS than SPS in group I and similar for SPS and LPS in group II DISCUSSION: The posterior glenoid screw contributes significantly to stability of the reverse glenoid base plate. If an SPS does not obtain good purchase into the scapula, glenoid component fixation will be enhanced by the addition of an LPS into the scapular spine.