Epidemiology, Performance, and Return to Sport After Rib Fracture in Professional Baseball Players

Background: Baseball players are vulnerable to stress-related injuries due to the biomechanics required to perform successfully, and stress fractures can occur via overuse. Baseball players can also sustain traumatic fractures via collision. Rib fractures are among the most common injuries of the chest in professional baseball players, yet literature is lacking regarding the characteristics of these injuries and the subsequent missed time and effect on performance. Purpose: To evaluate in professional baseball players (1) the epidemiologic characteristics of rib fractures, (2) the differences between traumatic and stress rib fractures, (3) the effect of rib fracture on performance, and (4) the return-to-sport (RTS) time and rate after rib fracture. Study Design: Cohort study; Level of evidence, 3. Methods: The Major League Baseball Health and Injury Tracking System database was utilized to obtain fracture data between 2011 and 2022. The authors analyzed differences in stress and traumatic fractures across position groups and compared time missed and performance data for each fracture type. Results: A total of 121 fractures (54 stress, 57 traumatic, and 10 not specified) were identified: 42 MLB players and 79 Minor League Baseball players. The mean time missed for rib stress fractures was significantly higher at 98.13 ± 11.19 days compared with traumatic fractures (47.44 ± 6.23 days) ( P < .001). Pitchers missed more time (99.93 ± 84.94 days) than infielders (42.83 ± 41.71 days) ( P < .001). When assessing the effect of rib fractures on performance, position players had lower on-base percentage ( P = .008) upon RTS as compared with before injury. In pitchers, a longer RTS time correlated with fewer innings pitched upon RTS . Conclusion: Professional baseball players who sustain rib stress fractures have a longer RTS time than those who sustain traumatic injuries. Athletes needed approximately 14 and 7 weeks to RTS after stress and traumatic fractures, respectively. Pitchers who sustained stress fractures had the longest RTS time at 17.6 weeks. Position players experienced significant decline in 1 out of 15 performance metrics indicating a minimal decline in performance upon return.