Abstract
BackgroundThere exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons.The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations.MethodsA 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario.ResultsThere was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon’s own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02).ConclusionWhile there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.
Highlights
There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons
There, is a mixed consensus on management of diaphyseal clavicular fractures that are significantly displaced [8,9,10].The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures that do not meet traditional criteria for operative management with respect to fracture displacement and morphology
There was a statistically significant (Chi value 5.02, p = 0.02) difference between those who preferred operative management for a “healthy, working” patient (41%) compared to those who preferred operative management for an older patient with medical comorbidities (21%)
Summary
There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations. Treatment of diaphyseal humerus fractures can be operative or nonoperative. Decision making on treatment is multi-faceted and depends on location of injury, fracture morphology, accompanying neurovascular injuries, open or closed injuries and patient-associated factures. While there is much agreement regarding treatment of humeral shaft fractures if the above criteria met, the indications for treatment with respect to fracture morphology are not universally agreed upon. There still remains significant controversy on which fractures are indicated for operative management based purely on fracture morphology and displacement
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