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Shoulder and Elbow Fractures in Athletes

  • Injuries in Overhead Athletes (J Dines and C Camp, section editors)
  • Published:
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Abstract

Purpose of Review

The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact on the return to play.

Recent findings

Fractures of the shoulder and elbow can have profound implications in an athlete career. Recent technique of fractures management trended toward to preserve soft tissue which is critical for an early recovery in athletic population. Arthroscopy presents a strong interest for the treatment of intra-articular fracture, and minimally invasive approach as developed in humeral shaft fracture can be considered to avoid soft tissue damage.

Summary

Non-articular, stable, and minimally displaced fractures are mainly treated conservatively. However, we encourage a more aggressive approach in shoulder and elbow injuries in the athletes including minimally invasive and stable fixation to preserve vascularity and muscle environment.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Lawrence DW, Hutchison MG, Comper P. Descriptive epidemiology of musculoskeletal injuries and concussions in the National Football League, 2012–2014. Orthop J Sports Med. 2015;3(5):2325967115583653. https://doi.org/10.1177/2325967115583653.

    Article  PubMed  PubMed Central  Google Scholar 

  2. •• Conte S, Camp CL, Dines JS. Injury trends in major league baseball over 18 seasons: 1998–2015. Am J Orthop (Belle Mead NJ). 2016;45(3):116–23.

    Google Scholar 

  3. Robinson CM. Fractures of the clavicle in the adult: epidemiology and classification. J Bone Joint Surg Br Vol. 1998;80(3):476–84.

    Article  CAS  Google Scholar 

  4. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.

    Article  Google Scholar 

  5. Aitken SA, Hutchison JD, McQueen MM, Court-Brown CM. The importance of epidemiological fracture data: injury epidemiology for the non-epidemiologist. Bone Joint J. 2014;96–b(7):863–7. https://doi.org/10.1302/0301-620x.96b7.34023.

    Article  PubMed  Google Scholar 

  6. Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33(8):1142–6. https://doi.org/10.1177/0363546505274718.

    Article  PubMed  Google Scholar 

  7. Robertson GA, Wood AM, Bakker-Dyos J, Aitken SA, Keenan AC, Court-Brown CM. The epidemiology, morbidity, and outcome of soccer-related fractures in a standard population. Am J Sports Med. 2012;40(8):1851–7.

    Article  PubMed  Google Scholar 

  8. Bagherian S, Rahnama N. Epidemiology of injury in professional cyclists. Br J Sports Med. 2010;44(Suppl 1):i4–i.

    Article  Google Scholar 

  9. Nishimi AY, Belangero PS, Mesquita RS, Andreoli CV, Pochini AC, Ejnisman B. Frequency and risk factors of clavicle fractures in professional cyclists. Acta Ortop Bras. 2016;24(5):240–2.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Furey MJ, Zdero R, McKee MD. Clavicular refracture at the site of angular malunion in young athletes. J Orthop Trauma. 2017;31(4):e130–e2. https://doi.org/10.1097/bot.0000000000000765.

    Article  PubMed  Google Scholar 

  11. De Giorgi S, Notarnicola A, Tafuri S, Solarino G, Moretti L, Moretti B. Conservative treatment of fractures of the clavicle. BMC Res Notes. 2011;4:333. https://doi.org/10.1186/1756-0500-4-333.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elb Surg. 2006;15(2):191–4. https://doi.org/10.1016/j.jse.2005.08.007.

    Article  Google Scholar 

  13. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. JBJS. 2012;94(8):675–84.

    Article  Google Scholar 

  14. Witzel K. Intramedullary osteosynthesis in fractures of the mid-third of the clavicle in sports traumatology. Z Orthop Unfall. 2007;145(5):639–42. https://doi.org/10.1055/s-2007-965616.

    Article  PubMed  CAS  Google Scholar 

  15. Meisterling SW, Cain EL, Fleisig GS, Hartzell JL, Dugas JR. Return to athletic activity after plate fixation of displaced midshaft clavicle fractures. Am J Sports Med. 2013;41(11):2632–6. https://doi.org/10.1177/0363546513501494.

    Article  PubMed  Google Scholar 

  16. Ranalletta M, Rossi LA, Piuzzi NS, Bertona A, Bongiovanni SL, Maignon G. Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes. Am J Sports Med. 2015;43(3):565–9. https://doi.org/10.1177/0363546514559913.

    Article  PubMed  Google Scholar 

  17. Verborgt O, Pittoors K, Van Glabbeek F, Declercq G, Nuyts R, Somville J. Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg. 2005;71(1):17–21.

    PubMed  Google Scholar 

  18. Ranalletta M, Rossi LA, Barros H, Nally F, Tanoira I, Bongiovanni SL, et al. Minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes. Am J Sports Med. 2017;45(2):462–7. https://doi.org/10.1177/0363546516666816.

    Article  PubMed  Google Scholar 

  19. Ekholm R, Adami J, Tidermark J, Hansson K, Tornkvist H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br Vol. 2006;88(11):1469–73. https://doi.org/10.1302/0301-620x.88b11.17634.

    Article  CAS  Google Scholar 

  20. Werner SL, Suri M, Guido JA Jr, Meister K, Jones DG. Relationships between ball velocity and throwing mechanics in collegiate baseball pitchers. J Shoulder Elb Surg. 2008;17(6):905–8. https://doi.org/10.1016/j.jse.2008.04.002.

    Article  Google Scholar 

  21. Singh AK, Narsaria N, Seth RR, Garg S. Plate osteosynthesis of fractures of the shaft of the humerus: comparison of limited contact dynamic compression plates and locking compression plates. J Orthop Traumatol. 2014;15(2):117–22. https://doi.org/10.1007/s10195-014-0290-2.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mahajan AS, Kim YG, Kim JH, D'sa P, Lakhani A, Ok HS. Is anterior bridge plating for mid-shaft humeral fractures a suitable option for patients predominantly involved in overhead activities? A functional outcome study in athletes and manual laborers. Clin Orthop Surg. 2016;8(4):358–66. https://doi.org/10.4055/cios.2016.8.4.358.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Usman J, McIntosh AS, Quarrie K, Targett S. Shoulder injuries in elite rugby union football matches: epidemiology and mechanisms. J Sci Med Sport. 2015;18(5):529–33. https://doi.org/10.1016/j.jsams.2014.07.020.

    Article  PubMed  Google Scholar 

  24. Goss TP. Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg. 1995;3(1):22–33.

    Article  PubMed  CAS  Google Scholar 

  25. Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Joint Surg Br Vol. 1984;66(5):725–31.

    Article  CAS  Google Scholar 

  26. Thompson DA, Flynn TC, Miller PW, Fischer RP. The significance of scapular fractures. J Trauma. 1985;25(10):974–7.

    Article  PubMed  CAS  Google Scholar 

  27. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395–7.

    Article  PubMed  CAS  Google Scholar 

  28. Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg. 2012;20(3):130–41. https://doi.org/10.5435/jaaos-20-03-130.

    Article  PubMed  Google Scholar 

  29. Schandelmaier P, Blauth M, Schneider C, Krettek C. Fractures of the glenoid treated by operation. A 5- to 23-year follow-up of 22 cases. J Bone Joint Surg Br Vol. 2002;84(2):173–7.

    Article  CAS  Google Scholar 

  30. Kavanagh BF, Bradway JK, Cofield RH. Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa. J Bone Joint Surg Am. 1993;75(4):479–84.

    Article  PubMed  CAS  Google Scholar 

  31. Harvey E, Audige L, Herscovici D Jr, Agel J, Madsen JE, Babst R, et al. Development and validation of the new international classification for scapula fractures. J Orthop Trauma. 2012;26(6):364–9. https://doi.org/10.1097/BOT.0b013e3182382625.

    Article  PubMed  Google Scholar 

  32. Neuhaus V, Bot AG, Guitton TG, Ring DC, Abdel-Ghany MI, Abrams J, et al. Scapula fractures: interobserver reliability of classification and treatment. J Orthop Trauma. 2014;28(3):124–9. https://doi.org/10.1097/BOT.0b013e31829673e2.

    Article  PubMed  Google Scholar 

  33. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res. 1991(269):174–80.

  34. DePalma A. Fractures of the scapula. Surgery of the shoulder. Philadelphia: Lippincott; 1983.

    Google Scholar 

  35. Jones CB, Sietsema DL. Analysis of operative versus nonoperative treatment of displaced scapular fractures. Clin Orthop Relat Res. 2011;469(12):3379–89. https://doi.org/10.1007/s11999-011-2016-6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35–46.

    Article  PubMed  CAS  Google Scholar 

  37. Rockwood CAMF. The scapula. The shoulder. Philadelphia: WB Saunders; 1990.

    Google Scholar 

  38. Chan YS, Chiu CH, Lo YP, Chen AC, Hsu KY, Wang CJ, et al. Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results. Arthroscopy. 2008;24(7):760–8. https://doi.org/10.1016/j.arthro.2008.02.017.

    Article  PubMed  Google Scholar 

  39. Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K. Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? J Bone Joint Surg Br Vol. 2008;90(6):778–85. https://doi.org/10.1302/0301-620x.90b6.19809.

    Article  CAS  Google Scholar 

  40. Bauer T, Abadie O, Hardy P. Arthroscopic treatment of glenoid fractures. Arthroscopy. 2006;22(5):569.e1–6. https://doi.org/10.1016/j.arthro.2006.01.003.

    Article  Google Scholar 

  41. Carro LP, Nunez MP, Llata JI. Arthroscopic-assisted reduction and percutaneous external fixation of a displaced intra-articular glenoid fracture. Arthroscopy. 1999;15(2):211–4. https://doi.org/10.1053/ar.1999.v15.015021.

    Article  PubMed  CAS  Google Scholar 

  42. Taverna E, Guarrella V, Freehill MT, Garavaglia G. Arthroscopic reduction with endobutton fixation for glenoid fracture. Joints. 2017;5(2):127–30. https://doi.org/10.1055/s-0037-1603675.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 1993;7(2):99–106.

    Article  PubMed  CAS  Google Scholar 

  44. Amis AA, Miller JH. The mechanisms of elbow fractures: an investigation using impact tests in vitro. Injury. 1995;26(3):163–8.

    Article  PubMed  CAS  Google Scholar 

  45. Ruchelsman DE, Christoforou D, Jupiter JB. Fractures of the radial head and neck. J Bone Joint Surg Am. 2013;95(5):469–78. https://doi.org/10.2106/jbjs.j.01989.

    Article  PubMed  Google Scholar 

  46. Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68(5):669–74.

    Article  PubMed  CAS  Google Scholar 

  47. Akesson T, Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Karlsson MK. Primary nonoperative treatment of moderately displaced two-part fractures of the radial head. J Bone Joint Surg Am. 2006;88(9):1909–14. https://doi.org/10.2106/jbjs.e.01052.

    Article  PubMed  Google Scholar 

  48. Herbertsson P, Josefsson PO, Hasserius R, Karlsson C, Besjakov J, Karlsson M. Uncomplicated mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study. J Bone Joint Surg Am Vol. 2004;86-a(3):569–74.

    Article  Google Scholar 

  49. Guzzini M, Vadala A, Agro A, Di Sanzo V, Pironi D, Redler A, et al. Nonsurgical treatment of Mason type II radial head fractures in athletes. A retrospective study. G Chir. 2017;37(5):200–5.

    PubMed  CAS  PubMed Central  Google Scholar 

  50. Burkhart KJ, Nowak TE, Kim YJ, Rommens PM, Muller LP. Anatomic fit of six different radial head plates: comparison of precontoured low-profile radial head plates. J Hand Surg. 2011;36(4):617–24. https://doi.org/10.1016/j.jhsa.2010.12.028.

    Article  Google Scholar 

  51. Smith AM, Morrey BF, Steinmann SP. Low profile fixation of radial head and neck fractures: surgical technique and clinical experience. J Orthop Trauma. 2007;21(10):718–24. https://doi.org/10.1097/BOT.0b013e31812e5168.

    Article  PubMed  Google Scholar 

  52. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am Vol. 2002;84–a(10):1811–5.

    Article  Google Scholar 

  53. Dunn JC, Kusnezov NA, Koehler LR, Eisenstein ED, Kilcoyne KG, Orr JD, et al. Radial head arthroplasty in the active duty military service member with minimum 2-year follow-up. J Hand Surg. 2017;42(8):660.e1–7. https://doi.org/10.1016/j.jhsa.2017.04.005.

    Article  Google Scholar 

  54. Hotchkiss RN. Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg. 1997;5(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  55. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. JBJS. 2004;86(8):1730–9.

    Article  Google Scholar 

  56. Court-Brown CM, Aitken SA, Forward D, O’Toole RV. The epidemiology of adult fractures. Philadelphia: Lippincott Williams & Wilkins; 2010.

    Google Scholar 

  57. Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of fractures of the proximal ulna. Injury. 2012;43(3):343–6. https://doi.org/10.1016/j.injury.2011.10.017.

    Article  PubMed  Google Scholar 

  58. Karlsson MK, Hasserius R, Karlsson C, Besjakov J, Josefsson PO. Fractures of the olecranon: a 15- to 25-year follow up of 73 patients. Clin Orthop Relat Res. 2002;403:205–12.

    Article  Google Scholar 

  59. Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin N Am. 2008;39(2):229–36, vii. https://doi.org/10.1016/j.ocl.2008.01.002.

    Article  Google Scholar 

  60. Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg. 2010;130(4):459–64. https://doi.org/10.1007/s00402-009-0980-z.

    Article  PubMed  Google Scholar 

  61. Cabanella ME, Morrey BF. Fractures of the proximal ulna and olecranon. The elbow and its disorders. Philadelphia: WB Saunders; 1993.

    Google Scholar 

  62. Hume MC, Wiss DA. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res. 1992;285:229–35.

    Google Scholar 

  63. Wolfgang G, Burke F, Bush D, Parenti J, Perry J, LaFollette B, et al. Surgical treatment of displaced olecranon fractures by tension band wiring technique. Clin Orthop Relat Res. 1987;224:192–204.

    Google Scholar 

  64. Newman SD, Mauffrey C, Krikler S. Olecranon fractures. Injury. 2009;40(6):575–81. https://doi.org/10.1016/j.injury.2008.12.013.

    Article  PubMed  CAS  Google Scholar 

  65. Anderson ML, Larson AN, Merten SM, Steinmann SP. Congruent elbow plate fixation of olecranon fractures. J Orthop Trauma. 2007;21(6):386–93. https://doi.org/10.1097/BOT.0b013e3180ce831e.

    Article  PubMed  Google Scholar 

  66. Gordon MJ, Budoff JE, Yeh ML, Luo ZP, Noble PC. Comminuted olecranon fractures: a comparison of plating methods. J Shoulder Elb Surg. 2006;15(1):94–9. https://doi.org/10.1016/j.jse.2005.06.003.

    Article  Google Scholar 

  67. Paci JM, Dugas JR, Guy JA, Cain EL Jr, Fleisig GS, Hurst C, et al. Cannulated screw fixation of refractory olecranon stress fractures with and without associated injuries allows a return to baseball. Am J Sports Med. 2013;41(2):306–12. https://doi.org/10.1177/0363546512469089.

    Article  PubMed  Google Scholar 

  68. Maffulli N, Chan D, Aldridge MJ. Overuse injuries of the olecranon in young gymnasts. J Bone Joint Surg Br Vol. 1992;74(2):305–8.

    Article  CAS  Google Scholar 

  69. Furushima K, Itoh Y, Iwabu S, Yamamoto Y, Koga R, Shimizu M. Classification of olecranon stress fractures in baseball players. Am J Sports Med. 2014;42(6):1343–51. https://doi.org/10.1177/0363546514528099.

    Article  PubMed  Google Scholar 

  70. Griggs SM, Weiss AP. Bony injuries of the wrist, forearm, and elbow. Clin Sports Med. 1996;15(2):373–400.

    PubMed  CAS  Google Scholar 

  71. Ahmad CS, Park MC, Elattrache NS. Elbow medial ulnar collateral ligament insufficiency alters posteromedial olecranon contact. Am J Sports Med. 2004;32(7):1607–12. https://doi.org/10.1177/0363546503263149.

    Article  PubMed  Google Scholar 

  72. Nuber GW, Diment MT. Olecranon stress fractures in throwers. A report of two cases and a review of the literature. Clin Orthop Relat Res. 1992;278:58–61.

    Article  Google Scholar 

  73. Cain EL Jr, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003;31(4):621–35. https://doi.org/10.1177/03635465030310042601.

    Article  PubMed  Google Scholar 

  74. Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower’s elbow. Tech Hand Upper Extrem Surg. 2003;7(4):197–216.

    Article  Google Scholar 

  75. Gregory B, Nyland J. Medial elbow injury in young throwing athletes. Muscles Ligaments Tendons J. 2013;3(2):91–100. https://doi.org/10.11138/mltj/2013.3.2.91.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Chen FS, Diaz VA, Loebenberg M, Rosen JE. Shoulder and elbow injuries in the skeletally immature athlete. J Am Acad Orthop Surg. 2005;13(3):172–85.

    Article  PubMed  Google Scholar 

  77. Sabick MB, Torry MR, Lawton RL, Hawkins RJ. Valgus torque in youth baseball pitchers: a biomechanical study. J Shoulder Elb Surg. 2004;13(3):349–55. https://doi.org/10.1016/s1058274604000308.

    Article  Google Scholar 

  78. Wilkins KE. Fractures involving the medial epicondylar apophysis. Fractures in children. Philadelphia: JB Lippincott; 1991.

    Google Scholar 

  79. Chen FS, Rokito AS, Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg. 2001;9(2):99–113.

    Article  PubMed  CAS  Google Scholar 

  80. Miller CD, Savoie FH 3rd. Valgus extension injuries of the elbow in the throwing athlete. J Am Acad Orthop Surg. 1994;2(5):261–9.

    Article  PubMed  CAS  Google Scholar 

  81. Sabick MB, Torry MR, Kim Y-K, Hawkins RJ. Humeral torque in professional baseball pitchers. Am J Sports Med. 2004;32(4):892–8.

    Article  PubMed  Google Scholar 

  82. Redler LH, Dines JS. Elbow trauma in the athlete. Hand Clin. 2015;31(4):663–81. https://doi.org/10.1016/j.hcl.2015.07.002.

    Article  PubMed  Google Scholar 

  83. Lawrence JT, Patel NM, Macknin J, Flynn JM, Cameron D, Wolfgruber HC, et al. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment. Am J Sports Med. 2013;41(5):1152–7. https://doi.org/10.1177/0363546513480797.

    Article  PubMed  Google Scholar 

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Marion Burnier and Jon D. Barlow declare no conflict of interest.

Joaquin Sanchez-Sotelo is a consultant for Stryker.

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Burnier, M., Barlow, J.D. & Sanchez-Sotelo, J. Shoulder and Elbow Fractures in Athletes. Curr Rev Musculoskelet Med 12, 13–23 (2019). https://doi.org/10.1007/s12178-019-09530-0

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