The NFL suffered another painful blow to their star power when Aaron Rodgers left during the 1st quarter of the Green Bay Packers game against the Minnesota Vikings after suffering a fracture of his right clavicle. Rodgers was tackled by Vikings linebacker Anthony Barr and was drilled into the ground. Barr was not penalized for the hit and while deemed legal by NFL rules many felt the roughness of the tackle was unnecessary. Rodgers will have surgery to repair the fracture which will likely end his regular season.
The mechanism of injury for Rodgers is typically how a clavicle fracture occurs which is a direct blow or fall onto the lateral shoulder. The most common area of the clavicle to be fractured is the middle third of the clavicle and these types of fractures typically heal well without surgery if the fracture is not complex or displaced. These type of fractures can heal with a period of immobilization in a sling. If the fracture is at the distal end of the clavicle or is a complex fracture, this will almost always require surgical treatment.
It has not come out what type of fracture Aaron Rodgers suffered but what we do know is that he will require surgical treatment which likely will involve an open reduction internal fixation. This means that the surgeon will need to perform an open surgery to allow them to put the fracture back in place and then use some type of fixation(Screw, nail, plate) to hold the fracture in place while it heals. Since the clavicle does move slightly with shoulder elevation, it is important to limit overhead activity for the first few weeks. Rodgers will likely be in a sling for the first 4-6 weeks and will not be able to start throwing until at least 3 months.
ouston’s first march toward the playoffs may have taken a fatal blow with back-up quarterback, Matt Leinart’s, clavicle fracture. Leinart suffered the left collarbone injury in the second quarter of the week 12 game against Jacksonville. This while the Texan’s first string QB, Matt Schaub, was on the sidelines in a walking boot because of a season-ending Lisfranc fracture (foot), sustained against Tampa Bay on November 13th.
Leinart isn’t the first quarterback to fracture his clavicle this season. That honor went to Jason Campbell, of the Oakland Raiders, who landed on his shoulder after being hit on October 16th. Campbell had surgery the following day to repair his fracture, and this week attempted, unsuccessfully, to begin a throwing program. It’s been written that Leinart’s treatment will be more conservative and simply entail wearing a sling and undergoing physical therapy.
So, why the difference in treatment?
The choice of how to address a fractured collarbone depends on several factors, including: the location of the fracture (whether it is toward one end of the bone or the other, or whether the injury is mid-shaft), whether the portions of the bone remain aligned or if they become displaced, or whether there are other complications from the trauma, such as a fractured scapula (shoulder blade), or injury to the brachial plexus (a network of nerves in the neck that extend to the underarm area). Plexus injuries are most likely to occur if the trauma forces the head away from the shoulder, putting the nerves on extreme stretch, or if a portion of a broken clavicle causes direct injury to the nerves.
Conservative (non-operative) treatment of mid-shaft fractures has been shown to have poor results, though there is risk of non-union (incomplete bone mending) with non-operative management of other types of clavicle fractures as well. Though there is often a deformity of the bone after conservatively managed clavicular fractures, healing is generally rapid and the deformity is not generally symptomatic. Of course, disuse of the upper extremity during the initial protective phase of healing (whether post-operatively or not) results in loss of strength, and therapy to restore strength, full range of motion in the shoulder and flexibility of the musculature is also necessary.
At it's inner end, the clavicle forms a joint with the sternum (breastbone), and at its outer end, it forms a joint with the scapula (shoulder blade). The latter, known as the AC joint (acromioclavicular joint), is often separated due to falls onto the shoulder.
There are several muscles that attach to the clavicle and these can exert forces on the fractured bone that pull the fragments apart, contributing to non-union. The central portion of the collarbone is least covered by muscle
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and is the region where these issues most often occur.
Here is a link to the summary of a study involving the management of middle-third clavicle fractures in the NFL. It discusses variable courses of care and length of time to return-to-play. After comparing cases over a five-year period, researchers concluded that displaced middle-third clavicle fractures were best treated surgically in order to “enable a successful clinical outcome in a predictable time frame.” I am assuming that Leinart’s fracture was non-displaced, without complications and possibly not mid-shaft, thereby allowing him to avoid surgery.
On an unrelated note, and for the record, it bears mentioning that CBS.Sports.com lists 46 players as having hamstring injuries. Yikes! Just thought you’d like to know…
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