Current concepts in distal clavicle fractures: an evidence-based update

Background: Clavicle fractures are common orthopaedic injuries that frequently occur during sports and recreational activity.Purpose: To (1) determine the incidence rate of sports-related clavicle fractures among patients evaluated in emergency departments in the United States over a 5-year period, (2) determine the most common sports and risks associated with clavicle fractures, and (3) update the literature by comparing past and present injury trends. Study Design: Descriptive epidemiology study.Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for patients evaluated with clavicle fractures in US emergency departments from 2015 to 2019.The authors evaluated the data by age, sex, race, and sport/recreational activity.Injuries were characterized based on sports-specific mechanism of injury.Using the NEISS weighted multiplier, the authors estimated annual incidence rates based on US Census data.Contingency table comparisons of categorical variables (ie, age groups vs sex distributions) were analyzed using either chi-square or Fisher exact tests as appropriate for the population size, while continuous variable comparisons were performed using 1-way analysis of variance statistical testing.Results: A total of 2386 athletic-related clavicle fractures were evaluated at participating emergency departments, translating to 304,211 clavicle fractures, with an annual per-year injury rate of 18.72 clavicle fractures per 100,000 persons at risk (95% CI, 15.28-23.67).Male athletes had disproportionately higher injury rates than female athletes (P < .001)for every year of the study and demonstrated a higher incidence of fractures compared with female athletes (injury proportion ratio, 5.54).Patients aged 10 to 19 years accounted for the highest overall incidence of injury (64.5%).The annual incidence rate of athletic-related clavicle fractures was not significantly different during the study period (P ¼ .24).The most common mechanisms of injury were participation in football (26.87%), soccer (15.76%), snowboarding (5.03%), bicycling (3.77%), wrestling (3.65%), and snow skiing (3.52%).Conclusion: Study findings indicated that clavicle fractures sustained during sports and recreational activity disproportionately affect male athletes.Adolescent populations (10-19 years of age) had the highest overall incidence of injury, and the most common activities associated with clavicle fractures were football and soccer.