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Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review

BACKGROUND: Stress fractures of the elbow are rare in throwing athletes and present a challenge from both a management and rehabilitation perspective. Although the incidence of stress fractures of the elbow is increasing, there is a lack of data in the literature focused on throwers. PURPOSE: To eva...

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Autores principales: Smith, Shelby R., Patel, Nirav K., White, Alex E., Hadley, Christopher J., Dodson, Christopher C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176543/
https://www.ncbi.nlm.nih.gov/pubmed/30306096
http://dx.doi.org/10.1177/2325967118799262
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author Smith, Shelby R.
Patel, Nirav K.
White, Alex E.
Hadley, Christopher J.
Dodson, Christopher C.
author_facet Smith, Shelby R.
Patel, Nirav K.
White, Alex E.
Hadley, Christopher J.
Dodson, Christopher C.
author_sort Smith, Shelby R.
collection PubMed
description BACKGROUND: Stress fractures of the elbow are rare in throwing athletes and present a challenge from both a management and rehabilitation perspective. Although the incidence of stress fractures of the elbow is increasing, there is a lack of data in the literature focused on throwers. PURPOSE: To evaluate studies regarding the management and outcomes of stress fractures of the elbow in throwing athletes. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was conducted by searching the Scopus, PubMed, and Cochrane Library electronic databases to identify studies reporting on the management and outcomes of stress fractures in overhead-throwing athletes. Management data included nonoperative and operative modalities, and outcome data included return to play, encompassing the timing and level of activity. Studies were excluded if the stress fracture of the elbow was not a result of a sport injury attributed to throwing or if the study failed to report whether an athlete returned to play. RESULTS: Fourteen studies met the inclusion criteria and were included in this analysis. There were 52 patients in total (50 male, 2 female) with a mean age of 19.7 years (range, 13-29.1 years). The olecranon was the most common location of the stress fracture (51 patients; 98.1%), followed by the distal humerus (1 patient; 1.9%). The majority of patients (n = 40; 76.9%) were treated operatively. Of the 40 patients who were treated surgically, 14 (35.0%) underwent a period of conservative treatment preoperatively that ultimately failed because of persistent nonunion or continued elbow pain. A total of 50 patients (96.2%) returned to sport either at or above their preinjury level. Of the 2 patients (3.8%) who did not return to sport, 1 did not return because of continued elbow pain postoperatively, and the other was lost to follow-up. Complications occurred in 9 patients (17.3%), all of whom were treated surgically. CONCLUSION: On the basis of this systematic review, the majority of elbow stress fractures were treated operatively and approximately one-third after a period of failed nonoperative management. The return-to-sport rate was high. Further, higher level studies are needed to optimize management and return-to-sport rates in this population.
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spelling pubmed-61765432018-10-10 Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review Smith, Shelby R. Patel, Nirav K. White, Alex E. Hadley, Christopher J. Dodson, Christopher C. Orthop J Sports Med Article BACKGROUND: Stress fractures of the elbow are rare in throwing athletes and present a challenge from both a management and rehabilitation perspective. Although the incidence of stress fractures of the elbow is increasing, there is a lack of data in the literature focused on throwers. PURPOSE: To evaluate studies regarding the management and outcomes of stress fractures of the elbow in throwing athletes. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was conducted by searching the Scopus, PubMed, and Cochrane Library electronic databases to identify studies reporting on the management and outcomes of stress fractures in overhead-throwing athletes. Management data included nonoperative and operative modalities, and outcome data included return to play, encompassing the timing and level of activity. Studies were excluded if the stress fracture of the elbow was not a result of a sport injury attributed to throwing or if the study failed to report whether an athlete returned to play. RESULTS: Fourteen studies met the inclusion criteria and were included in this analysis. There were 52 patients in total (50 male, 2 female) with a mean age of 19.7 years (range, 13-29.1 years). The olecranon was the most common location of the stress fracture (51 patients; 98.1%), followed by the distal humerus (1 patient; 1.9%). The majority of patients (n = 40; 76.9%) were treated operatively. Of the 40 patients who were treated surgically, 14 (35.0%) underwent a period of conservative treatment preoperatively that ultimately failed because of persistent nonunion or continued elbow pain. A total of 50 patients (96.2%) returned to sport either at or above their preinjury level. Of the 2 patients (3.8%) who did not return to sport, 1 did not return because of continued elbow pain postoperatively, and the other was lost to follow-up. Complications occurred in 9 patients (17.3%), all of whom were treated surgically. CONCLUSION: On the basis of this systematic review, the majority of elbow stress fractures were treated operatively and approximately one-third after a period of failed nonoperative management. The return-to-sport rate was high. Further, higher level studies are needed to optimize management and return-to-sport rates in this population. SAGE Publications 2018-10-08 /pmc/articles/PMC6176543/ /pubmed/30306096 http://dx.doi.org/10.1177/2325967118799262 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Smith, Shelby R.
Patel, Nirav K.
White, Alex E.
Hadley, Christopher J.
Dodson, Christopher C.
Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review
title Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review
title_full Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review
title_fullStr Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review
title_full_unstemmed Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review
title_short Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review
title_sort stress fractures of the elbow in the throwing athlete: a systematic review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176543/
https://www.ncbi.nlm.nih.gov/pubmed/30306096
http://dx.doi.org/10.1177/2325967118799262
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