Management of sport-related fractures: operative versus non-operative management

Abstract

Background: Fractures are the most serious injury suffered by athletes, resulting in the greatest time recuperating from Such injuries. Objectives: To describe the difference in outcome for non-operative versus operative management of site-specific soccer-related fractures. Methods: All fractures sustained during soccer from 2007 to 2008 within the Lothian population were prospectively recorded. Patients were followed up in August 2010, via telephone, to determine return rates and times to soccer. High incidence fractures with significant rates of surgery (Tibial Diaphysis, Ankle, Scaphoid, Clavicle, Metacarpus Distal Radius) were identified and classified according to the AO system. Outcomes of similar fracture classifications with contrasting management were compared. Results: Of 367 fractures identified during the study period, 20% were managed operatively. The rates of surgery for the six fractures cohorts were Tibial Diaphyseal 67%, Ankle 51%, Scaphoid 25%, Clavicle 20%, Metacarpal 11% and Distal Radial 10%. Operatively managed fractures of the Distal Radius (14 weeks vs. 9 weeks: P < 0.031), Ankle (42 weeks vs. 22 weeks: P < 0.004) and Metacarpus (18 weeks vs. 5 weeks: P < 0.001) took longer to return to soccer than non-operatively managed fractures, while operatively managed fractures of the Tibial Diaphysis took shorter to return (35 weeks vs. 45 weeks: P = 0.673). Operatively managed fractures of the Ankle (57% vs. 22%: P < 0.029), Tibial Diaphysis (89% vs. 50%: P = 0.683), Scaphoid (80% vs. 60%: P = 0.613), Clavicle (50% vs. 31%: P = 0.584), Distal Radius (50% vs. 18%: P = 0.234) and Metacarpus (67% vs. 40%: P = 0.537) had higher rates of persisting symptoms at follow-up than non-operatively managed fractures. Conclusions: The role of operative management in the treatment of soccer-related fractures is specific to the location and nature of the fracture. The effect of operative management on return times to sport is fracture specific, though invariably this is associated with higher rates of persisting symptoms. The decision regarding the choice of non-operative versus operative management requires clinical judgment on an individual basis, based on the fracture location and configuration.