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Postoperative recreational sports and subjective shoulder function: a comprehensive analysis following intramedullary stabilization of displaced midshaft clavicular fractures

  • Trauma Surgery
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Abstract

Introduction Sports-related outcomes and the role of recreational sports activities for shoulder function after intramedullary stabilization (IMS) of displaced midshaft clavicular fractures (DMCFs) in the general population are not well known. In this study, we aimed to determine the sport-related outcomes (return-to-sports [RTS] rate, type of sports, time until RTS, and intensity) and to explore the role of sports after IMS of DMCFs. Materials and Methods This single-center, retrospective, cohort study included patients who underwent IMS of DMCFs between 2009 and 2022 at a Level II trauma center in Germany, experienced no major complications, and had completed at least 1 year of follow-up. Propensity score matching was conducted to obtain a balanced sample of patients who did not engage (cases) and engaged (controls) in postoperative sports activities by adjusting for age and fracture complexity. Groups were compared to assess the impact of regular sports activities on subjective shoulder functioning at follow-up, as evaluated using the Disabilities of the Arm, Shoulder, and Hand and Oxford Shoulder Score (OSS) questionnaires, after controlling for the patient- (i.e., sex and smoking) and treatment- (i.e., surgery duration and physical therapy) factors. Results Among the 199 patients included, the RTS rate was 97.5%, and 160 patients practiced regular postoperative activity, mostly in the same sport and intensity. In the matched cohort (39 cases and 39 controls), practicing regular sports activities postoperatively was the only independent factor associated with a higher OSS in the multiple regression analysis (unstandardized regression coefficient = 2.40; Bias-corrected and accelerated 95% confidence interval [0.28, 4.69]). Conclusions The sport-related outcomes after IMS of DMCFs in our cohort were comparable to those achieved after plate osteosynthesis, and IMS reported in the literature. Recreational sports activities benefitted subjective shoulder function, thereby encouraging further research and potentially influencing management policies. Level of evidence Grade IV – a retrospective observational cohort study.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing and Paul Schatz for the support in reviewing the manuscript. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

The authors have no funding.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hegau-Bodensee-Klinikum Singen, Health Care Association District of Constance (GLKN), Virchowstrasse 10, D-78224, Singen, Germany

    Ronny Langenhan, Axel Probst & Stefanie Bushuven

  2. Health Care Association District of Constance (GLKN), Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Kapellenstrasse 31, D-78262, Gailingen, Germany

    Stefan Bushuven

  3. Training Center for Emergency Medicine (NOTIS e.V.), Breite Strasse 7, D-78234, Engen, Germany

    Stefan Bushuven & Milena Trifunovic-Koenig

  4. Department of Neurorehabilitation, Health Care Association District of Constance (GLKN), Hegau-Jugendwerk Gailingen, Kapellenstrasse 31, D-78262, Gailingen, Germany

    Stefanie Bushuven

  5. Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, Rhein-Main University of Applied Sciences, Kurt-Schumacher-Ring 18, D-65197, Wiesbaden, Germany

    Milena Trifunovic-Koenig

  6. Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center—University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany

    Stefan Bushuven

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  1. Ronny Langenhan
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Contributions

All authors contributed to the study´s conception and design. Material preparation, data collection, and analysis were performed by Ronny Langenhan and Milena Trifunovic-Koenig. The first draft of the manuscript was written by Ronny Langenhan and Milena Trifunovic-Koenig, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ronny Langenhan.

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Ethical approval

The study was approved by the competent Ethics Committee (Landesärztekammer BW; approval number F-2021-048) and was conducted in accordance with the principles set forth in the Helsinki Declaration of 1964 and national regulations.

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Informed consent was obtained from all participants included in the study. Data were processed under German national terms and regulations.

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Langenhan, R., Probst, A., Bushuven, S. et al. Postoperative recreational sports and subjective shoulder function: a comprehensive analysis following intramedullary stabilization of displaced midshaft clavicular fractures. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05319-0

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