A soccer player with a displaced medial clavicle fracture achieved radiographic consolidation and was cleared for unrestricted sports participation about 8 weeks after receiving adjunctive focused electrohydraulic shockwave therapy.
The case report described a 14-year-old female soccer player who sustained a displaced right medial clavicle fracture after falling onto her shoulder during a match. Emergency department radiographs confirmed the injury, and an orthopedic evaluation on Day 3 recommended nonoperative management with an anticipated recovery period of at least 12 weeks. Focused electrohydraulicextracorporeal shockwave therapy was initiated on Day 4, with 18 sessions completed by Day 57. Treatment consisted of 3 sessions per week, reduced to 2 sessions per week, using 1,500 shockwaves per session at an energy flux density of 0.05 to 0.06 mJ/mm².
Researchers assessed clinical recovery, radiographic fracture healing, and readiness for unrestricted sports participation. Evaluations included pain, shoulder mobility, functional improvement, fracture consolidation, and treatment-related complications, with clinical follow-up extending to about 1 year postinjury.
By Day 59, radiographs demonstrated robust callus formation and fracture consolidation. Orthopedic examination confirmed mechanical stability, full functional shoulder use, and absence of pain, supporting clearance for unrestricted sports participation. The timeline was shorter than the mean return-to-play interval of 103 days reported in a previously published systematic review of clavicle fractures, although differences in patient populations and fracture characteristics limited direct comparison.
Clinical improvement was evident earlier in treatment. The patient reported reduced pain following the initial session and improved shoulder movement by the fifth treatment. Day 15 radiographs demonstrated early callus formation, while by Day 21, the patient could raise her arm overhead and perform daily activities. Repeat imaging on Day 31 showed progressive callus maturation.
Despite these improvements, radiographs obtained on Day 50 demonstrated mild apparent separation at the fracture site after the patient resumed carrying a heavy backpack. The researchers considered premature loading a possible contributor but acknowledged that differences in radiographic positioning and magnification could explain the apparent change. The patient was advised to discontinue backpack use, underscoring the importance of maintaining activity restrictions despite symptom resolution.
At about 1 year postinjury, the patient remained asymptomatic without recurrent pain, functional limitations, reinjury, or additional treatment. No treatment-related adverse events, respiratory symptoms, or neurovascular complications were reported butradiographic healing was not reassessed at the 1-year visit.
The single-patient design, absence of a comparison group, and potential influence of natural pediatric healing prevented conclusions about treatment efficacy. Standardized pain and functional assessments were unavailable, and radiographic evaluations lacked independent blinded review. The treatment protocol was selected empirically, and historical recovery estimates were drawn from heterogeneous clavicle fracture populations rather than directly comparable adolescent patients with medial-third fractures.Although recovery occurred sooner than anticipated, the findings did not establish whether the treatment accelerated healing.
“These findings remain hypothesis-generating, and further prospective studies are warranted to define its role, safety, and efficacy in pediatric populations,” wrote study authors Allen Manison, of Columbia Advanced Chiropractic, and Morris Brian Polsky, of the University of Maryland School of Medicine.
The study authors reported no conflicts of interest.
Source: Case Reports in Orthopedics
