Abstract
Purpose of ReviewOperative and non-operative treatment of midshaft clavicle fractures seems to yield comparative functional results. Furthermore, it has been suggested that surgery is more expensive compared with non-operative treatment of clavicle fracture. Cost-effectiveness seems to be more important in trends of treatment decisions. The purpose of this study is to investigate the cost-effectiveness of clavicle fracture treatment.Recent FindingsSeven publications were selected, and 5 studies showed that operative treatment is more expensive than non-operative treatment. The mean overall cost per person in discounted prices was 10,230 USD for operative and 7923 USD for non-operative treatment. The mean absence from work ranged 8–193 and 24–69 days for operative and non-operative treatment, respectively. Studies varied in methods of assessing the cost-effectiveness of treatment modalities.SummaryBased on this literature review, routine operative treatment seems to be more expensive. In some cases, operative treatment might be more cost-effective. In all studies, direct and indirect costs of health care were calculated, but a great heterogeneity exists in the sources of cost data between countries. The cost-effectiveness of the treatment of clavicle fracture depends strongly on the cost of operative treatment and length of absence from work. Cost-effectiveness analysis could be a routine in RCT studies in the future.
Highlights
Clavicle fractures in the adult population represent approximately 3% of all fractures and 44% of those in the shoulder area [1]
Accepted indications for operative intervention in clavicle fractures include open fractures, fractures associated with skin compromise, and concomitant neurological or vascular injury
The following keywords combined with Medical Subject Headings (MeSH) terms were used in the search: “economic OR cost OR costs OR cost savings OR effective OR cost-effective OR cost effectiveness OR cost effectiveness” and “clavicle OR clavicular OR collar bone.”
Summary
Clavicle fractures in the adult population represent approximately 3% of all fractures and 44% of those in the shoulder area [1]. Accepted indications for operative intervention in clavicle fractures include open fractures, fractures associated with skin compromise, and concomitant neurological or vascular injury. Relative indications for operative treatment include fractures with more than 2-cm shortening, severe displacement of the fracture, concomitant chest injuries, high-energy injuries, a floating shoulder, and fracture non-unions [2–8]. To the best of our knowledge, 9 RCTs comparing open reduction with plate fixation and nonoperative treatment exist [8, 9, 12, 13, 14, 15, 16, 17, 18]. The results of these recent RCTs show that there is little or no difference in functional outcome at 1- and 2-year follow-up between operative and non-operative treatment. Comparison between the different RCTs is demanding due to high heterogeneity of outcomes [24]
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