What does clavicle fracture mean for Foles?

After Sunday’s Eagles win against Texas where Nick Foles sustained an injury to his left shoulder, everyone has been discussing the odds of whether he will be able to return to play this season and whether he will need to undergo surgery to repair the damage. When it comes to clavicle fractures, type of treatment depends upon displacement.

In the past, most clavicle fractures have been treated nonoperatively. This meant being in a sling while the fracture healed and then rehab to address the loss of motion and strength from being in the sling. Newer technologies with surgical repair involving internal fixation with a plate and screw though tend to have better outcomes and have resulted in a shift towards surgical repair.

Fractures that are displaced, where an obvious fracture is evident on x-ray and where shortening of the bone’s overall length occurs, are best served with surgical repair. Over 30% of patients who have non-operative treatment of a displaced middle third clavicle fracture have been reported to have unsatisfactory results. The result can be persistent weakness of the shoulder and loss of endurance. Surgical repair affords the advantage of an anatomic repair which restores the bone to the original position and length resulting in improved shoulder function. It also reduces the incidence of non-union, which is a non-healing of the fracture, and also reduces problems with malunion where the fracture heals in an undesired and crooked position.

Fractures that are non-displaced, or in other word simply a crack in the bone, however, do not require plating. These fractures will heal within 6 to 8 weeks.

A 2010 American Journal of Sports Medicine review of clavicle fractures in the NFL conducted by Robert Morgan showed that immediate surgical repair was performed in approximately half of all fractures. Surgery for the displaced fractures healed in an average of 8.8 weeks without any further problems, and half of these players returned in the same season. 50% of players initially treated without surgery for displaced fractures went on to not heal or ended up re-fracturing their clavicle within a year. This obviously can present significant problems at the NFL level. All the fractures that were not displaced healed in an average of a little over seven weeks with a range of 6-8 weeks.

What does this mean for Foles? It was his non-throwing shoulder which is a positive. Coach Kelly stated that Foles has a “cracked clavicle.” Hopefully this means it’s a non-displaced fracture which means he could be back this season. For comparison, Aaron Rodgers returned 7 weeks after a non-displaced clavicle fracture last season.  In theory, this time frame puts Foles back for December 20th game against Washington.