Management trends of clavicular fractures at a level 1 trauma center: a retrospective chart review

Abstract

Background: Controversy remains regarding optimal treatment of clavicular fractures, despite evidence touting lower nonunion rates for operative interventions. Given increasing evidence supporting operative treatment, the goal of this study was to observe trends in operative versus nonoperative treatment over a 15-year period. Methods: One thousand and eighty nine patients with any clavicular fracture (AO Foundation/Orthopaedic Trauma Association 15A to 15AC) between 2004 and 2018 were identified. Patient records were queried for demographic information, injuries to the head or chest, and treatment modality (operative vs. nonoperative). Independent sample t-tests, Fisher exact, or chi-square tests were used for analysis, with P less than 0.05 representing significance. Results: Of the 1089 qualified patients, the average age was 47.5 yr and 70.7% were men. Two hundred forty-two patients (20.2%) were managed operatively. Two hundred seventy-one patients (24.8%) had isolated injuries. Operative clavicle management increased from 6.4% of patients in 2004 and 2005 to 31.5% in 2018 (P<0.001). During this time, both patient age and chest-injury rates increased (both P<0.01). Patients with head injuries had a fixation rate of 4.8%, compared with 45.5% in patients with chest injuries. Those fixation rates differed from the rate for isolated clavicular fractures (30.9%) and those polytraumatized patients who had both chest and head injuries (18.8%) (P=0.026). Conclusions: Our data indicated that from 2004 to 2018, there was a five-fold increase in the rate of operative management of clavicular fractures. This rise in fixation rates may substantially influence the rate of complications, secondary surgeries, and cost of additional healthcare utilization. It is important to counsel patients individually to limit unnecessary surgery. Level of Evidence: Level IV.