Return to Play Following Metacarpal Fractures in Football Players

Abstract

Objectives:Injuries involving fractures of the metacarpals are common among football players of all levels. These injuries are typically treated conservatively with casting or splinting among non-in-season athletes, a method that involves a relatively lengthy recovery time (four weeks). To our knowledge, there are no previous reports documenting return to play in elite football players after operative management of metacarpal fractures. The purpose of this study was to retrospectively review and describe the results of operative treatment of metacarpal shaft fractures in 19 high level football players with respect to return to play. We hypothesized that in-season football players with metacarpal fractures treated surgically would be able to return to play more quickly than the typical recovery time following non-operative treatment.Methods:Surgically treated metacarpal fractures in elite football players were queried over a three-year period (2009-2012) from a database maintained by American Sports Medicine Institute (ASMI) in Birmingham, AL. Over the study period, 19 football players were identified who underwent open reduction internal fixation of metacarpal fractures by one of three attending surgeons. Retrospective chart review and phone interviews with the patient and their athletic trainers were performed to identify player position, level of competition, mechanism of injury, return to play, post-operative bracing, and re-fracture event. Radiographs were used to classify the fractures, and operative reports were reviewed for implant choice. Numerical means were calculated for in-season return to play as well as for brace time.Results:Ten high school players (53%) and nine college players (47%) were injured. The most common injured positions were wide receivers and defensive backs (26% each). Most injuries occurred through player to player contact (63%) at a game (37%) or practice (47%). The long finger (58%) was the most commonly involved metacarpal. Two players (11%) had multiple metacarpal fractures. The most common location was mid-diaphyseal (74%). Twelve patients were stabilized with plates and screws, five of whom underwent lag screw augmentation. Six patients were stabilized with a metacarpal nail and one was stabilized with only lag screws. All athletes were able to return to their pre-injury level of play without recurrence of fracture. Return to play for in-season athletes (N=11) was 6.3 days. The average time to return to play for in-season high school football players (N=6) was 9.2 days and 2.8 days for in-season collegiate football players (N=5). All in-season athletes returned to play with protective equipment in the form of a padded glove, bivalve padded cast, padded club cast, or padded splint. The protective equipment was used for an average of 21 days.Conclusion:This study provides support for the surgical treatment of displaced metacarpal shaft fractures with immediate return to play as tolerated for in-season football players. No re-fractures or complications were identified with the use...

Finger Injuries in Football and Rugby

“…39 Fractures occur most commonly in the mid-diaphysis of the metacarpal; the long finger is most commonly injured. 39 80% of metacarpal fractures in athletes are minimally or nondisplaced, 5% remain stable after reduction and can be maintained with functional bracing, and the remaining 15% require surgical treatment. 40 …”

“…7 For collegiate and high school football athletes, protective splints were used for an average of 21 days. 39 Glove casts can be used to immobilize a stable metacarpal fracture will permitting continued range of motion and use of the wrist. 10 …”

“…41 Others report return to play in less than 10 days following surgery for a metacarpal fracture for high school athletes and in less than 3 days for college football players with no additional incidence of postoperative hardware failure or wound complications. 39 …”

“…Padded gloves, a bivalved padded cast, a padded club cast, and a padded splint may also be worn. 39 Skilled position players often use padded gloves when they return to protected play. Nonskilled position players can return sooner with greater protective offered by padded casts.…”

Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture

“…Outcomes after various orthopaedic procedures have been documented in a number of professional athletes from the National Basketball Association (NBA), 1,5,9,10,37 National Football League (NFL), 2,4,6,31 Major League Baseball (MLB), 7,21,28 and National Hockey League (NHL). 12,26,30 Despite near limitless resources to help facilitate appropriate rehabilitation, an Achilles tendon rupture can be a career-threatening injury among elite athletes.…”