Background

Clavicle fractures are amongst the most common injuries sustained by road cyclists, but there is little evidence in the literature about return to competition times in elite athletes.


Objectives

Our aim was to investigate the return to competition time and risk factors for delayed return.

Study Design & Methods

We used an online database to identify cyclists who sustained a clavicle fracture between 2015-2020. Freely available online records were reviewed to validate the data for the primary outcome which was return to competition time. Secondary outcomes included return to outdoor cycling time, operative or non-operative management, time to surgery, cause of injury, other injuries, and ability to complete the event they returned to. Statistical analysis was performed using Microsoft Excel, with t-tests performed to identify a statistically significant difference between subgroups.

Results

We reviewed records of 1,117 cyclists (669 male, 448 female) and identified 157 with clavicle fractures. Recurrent fractures were excluded, leaving 140 first time fractures. 139 returned to elite competition (99.3%), and the overall mean time to return to competition was 54 days for females (18/139) and 60 days for males (p=0.51, range 14-206 days). However, injuries sustained during January - July, demonstrated a mean return to competition of 53 days, compared to 97 days when the injury occurred from September – December (p<0.05). Where it was possible to obtain data on the management, 80% (98/122) underwent surgery at an average of 2.7 days post injury. There was no significant difference in the time to return to competition between those who had surgical (61 days) and non surgical management (51 days, p=0.15). Those who sustained isolated clavicle fractures (108/139) returned significantly quicker than those who sustained other injuries at the same time (55.4 vs 75.5 days, p<0.05). The most common cause was a crash with other cyclists. The average return to outdoor cycling was 25 days and 90% completed the event they returned to.

Conclusions

This is the largest study of return to competition in elite athletes with clavicle fractures. Elite cyclists are at high risk of clavicle fractures and the majority are managed surgically. Cyclists who sustained isolated clavicle fractures at the start of the season returned significantly quicker. Although there was no significant difference in return times for those undergoing surgical or conservative management, this includes all reported clavicle fractures, and it was not always possible to determine the type or grade of injury. We would therefore not support the use of these findings to determine the management of different fracture patterns.

Road cyclists with isolated clavicle fractures able to return the same season did so at an average of 46.5 days post injury.
The return to competition time is higher than is often expected by the media, and this data can help to plan rehabilitation programmes, and manage expectations in both professional and amateur cyclists.