The impact of clavicle fractures on return to play in NFL athletes

Aaron Rodgers, quarterback of the NFL’s Green Bay Packers — photo Mike Morbeck Wikimedia

I love sports as well as sports medicine.  For many of us, our path to this field saw us grow from athletes or fans ourselves to physicians who kept ‘in the game’ by caring for other athletes and keeping them in the game.

I have written about my affection for my favorite professional team — the Green Bay Packers of the NFL. Anyone following the Packers this season, or the NFL in general, will know that Aaron Rodgers, the team’s franchise quarterback (and sine qua non), sustained a potentially season-ending clavicle fracture to his right, throwing shoulder in October. He has been out since — and his team, its fans (me!), and multiple fantasy football team owners are anxiously awaiting his return.  There is growing expectation he will be back next week for the Packers’ final three games of the season. Go Pack Go!

“The waiting is the hardest part,” Tom Petty (RIP) has sung. And the waiting for Rodgers has been very hard for the Packers. Indeed, for anyone experiencing or managing a clavicle fracture, a lot of the frustration comes from the typically temporary but lengthy disability incurred — in the middle of an athlete’s season, a clavicle fracture can be the darnedest thing.  One is waiting as if for a batch of cookies to be done — take them out of the oven too early, you may be ruining a good thing; wait too long, you may unnecessarily be keeping your player out of the game.

With the ‘waiting’ for Rodgers on my mind, I read with special interest this morning a new, ‘published online first’ study from CJSM: Impact of Clavicle Fractures on Return to Play and Performance Ratings in NFL Athletes.  The study was a retrospective cohort study in which the authors looked at NFL players who sustained a clavicle fracture from 1998 to 2015 and returned to the field after the injury during the study period (N = 17).

The authors set out to determine how long it took for a player to return to the field of play (something that has been done before) and what the quality of their play was like on their return (something new in the medical literature).

They found that the median time for return to play was a whopping 3.47 months (8 games) [in Rodgers’ case, this season, it looks as if he may be back in a briefer time, missing 7 games].

What is more, though the sample size in this study was small, the authors found no significant effect on athletic improvement on return to play (great news for the Pack!). The authors determined this by looking at position-matched, uninjured controls and sifting through official NFL published performance data (e.g. offensive, defensive stats) collected through the course of a regular season. They specifically calculated offensive and defensive ‘power ratings’ using previously published methodology (1), and did group comparisons of cases and controls, including subgroup analyses (e.g. looking at quarterbacks alone).

I’d encourage you to take a look at the study.  Given that clavicle fractures are quite common and typically cause a significant loss of playing time [third longest timeline for return to play among sports-related fractures(2,3)], it behooves a sports medicine clinician to better understand these ‘bad actors.’

This is the type of study we love to publish at CJSM: clinically relevant original research.  If you have ideas like this which you have studied and written up, send them our way.

In the mean time, I’ll be sitting down to watch the Packers this weekend without Aaron Rodgers, and hoping he’ll be out on the field next week.

____________________________________________________

1. McHale KJ, Rozell JC, Milby AH, et al. Outcomes of Lisfranc injuries in
the National Football League. Orthopaedic J Sports Med. 2016;44:
1810–1817.

2. Court-Brown CM, Wood AM, Aitken S. The epidemiology of acute
sports-related fractures in adults. Injury. 2008;39:1365–1372.

3. Robertson GAJ, Wood AM, Bakker-Dyos J, et al. The epidemiology,
morbidity, and outcome of soccer-related fractures in a standard
population. Am J Sports Med. 2012;40:1851–1857.