Clavicle Fractures Pro Cyclists 2021.pdf
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Clavicle fractures in cyclists with emphasis on the professional athlete
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Clavicle Fractures Pro Cyclists 2021.pdf
- 1. @theshoulderdoc Clavicle Fractures in Pro Cyclists Lennard Funk Wrightington Upper Limb Unit The Arm Clinic, Wilmslow Hospital
- 4. 1 Sports Injuries of the Shoulder Lennard Funk Mike Walton Adam C. Watts Mike Hayton Chye Yew Ng Editors 123 9 783030 230289 ISBN 978-3-030-23028-9 Sports Injuries of the Shoulder This book provides a practical guide detailing the aetiology, diagnosis, relevant pathology, management principles, and out- comes of a variety of injuries to the shoulder including rotator cuff disorders, glenoid bone loss, and pectoralis major ruptures in both elite and non-elite athletes. Each chapter features clinical pearls and a question and answer section to emphasize key points. Sports Injuries of the Shoulder is an essential book for those seeking an up-to-date resource. It is aimed at sports doctors and musculoskeletal doctors; senior orthopedic trainees with an interest in upper limb and those preparing for the FRCSOrth exam and similar international exams, as well as surgeons with a particular interest in shoulder conditions. Lennard Funk · Mike Walton · Adam C. Watts · Mike Hayton Chye Yew Ng Editors Sports Injuries of the Shoulder Funk · Walton · Watts Hayton · Yew Ng Eds.
- 5. @theshoulderdoc Plan 1. When to Fix in pro cyclists - & Why. 2. Fixation methods - pros & cons. 3. Return to cycling & competition - When & Why. 4. Metalwork removal - Why, When & Who!
- 6. @theshoulderdoc When & Why Fix
- 9. @theshoulderdoc Healing times & Delayed / Non-union = Pain & Disability
- 12. @theshoulderdoc Healing times & ➡ 28 year old male pro-cyclist Prognostic index = [-0.85 x (1 if displaced or 0 if undisplaced)] + [-0.36 x (1 if female or 0 if male)] + [-0.37 x (1 if comminuted or 0 if not)] + [-0.01 x (age of patient in years)] X X X
- 15. @theshoulderdoc Op vs Non-op? Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment. In terms of cost-effectiveness, operative treatment also seems to be advantageous. However, operative treatment is associated with an increased risk of complications and re- operations, while long-term shoulder functional outcomes are similar.
- 17. @theshoulderdoc Plate & Screws - ➡ Steel vs Titanium ➡ Low Profile ➡ Number of screws ➡ Locking vs non-locking ➡ Lag screws ➡ Working distance Keys to success
- 18. @theshoulderdoc Plates Steel Titanium 1. Stiffness & strength = Bone 2. Precontoured 3. Low profile 4. Chamfered ends 5. Locking options 6. But: 1. Expensive 2. Removal more difficult
- 20. @theshoulderdoc Literature: Operative vs. non operative 16.4 weeks vs. 28.4 weeks (COTS, JBJSA, 2007) When to Return to Sport?
- 21. @theshoulderdoc When to Return to Sport? ➡ Is Fixation strong enough to protect fracture against forces while it heals? (Load sharing) ➡ Time to radiographic union: Non-op 28.4wks vs Op 16.4 wks (Canadian Orth Trauma Society, 2007) ➡ Benefits vs Risks ➡ MDT Decision - ultimately Patient’s decision! (document) ➡
- 22. @theshoulderdoc Return to Cycling Pro cyclists average 3.6 weeks (range 2 to 6 weeks) std- 1.48 Pro motorcyclist average 7.6 weeks (range 2 to 12 weeks) std- 4.56 Social riders average 12.86 weeks (range 6 to 24 weeks) std- 6.72 Unpublished, Syed Shah & Len Funk, 2012
- 24. @theshoulderdoc Metalwork Removal ➡ Intramedullary device = 6-12 weeks ➡ Plate & Screws: 1. Symptomatic - prominent / pain / loose 2. Reduce risk of peri-implant fracture ➡ Rare with low profile, chamfered titanium plates 3. Patient preference ๏ Beware: Risks of removal - difficult; special kit; defects
- 25. @theshoulderdoc Summary ➡ Clavicle is unique - not long or flat bone ➡ Non-union = pain & dysfunction ➡ Union & RTS better with fixation ➡ Plate & screws standard ➡ Titanium precontoured, low profile ➡ RTS = when safe & MDT decision (patient-led) ➡ Removal should not be ‘routine’