Abstract
IntroductionThe clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database.MethodsCPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010–2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery.Results21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)—84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156).ConclusionsComplication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.
Highlights
The clinical and economic burden of clavicle fractures in England is not well documented
The peak incidence occurs in children and young adults; over one-third of clavicle fractures in males occur between the ages of 13 and 20 years, while 20% of clavicle fractures in females occur in this age group [3]
Operative treatment of clavicle fractures may be accomplished with open reduction and internal fixation (ORIF) using plates and screws or intramedullary fixation (IMF) [4]
Summary
The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database. The incidence of clavicle fractures is estimated to be 64 per 100,000 persons per year [1, 2]. Clavicle fractures typically occur due to falls on the lateral aspect of the shoulder, falls. Most clavicle fractures occur in the middle portion, or shaft, of the bone. Non-operative treatment options for clavicle fracture include pain reduction with analgesics and/or kinesiology tape, combined with temporary immobilization by sling or collar. Operative treatment of clavicle fractures may be accomplished with open reduction and internal fixation (ORIF) using plates and screws or intramedullary fixation (IMF) [4]. Orthopedic referral is indicated for significant fracture displacement, comminution, and shortening, the guidance on orthopedic referral being less directive for less severely displaced fractures [9,10,11]
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