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Comparative Study
. 2019 Sep 4;9(9):e031118.
doi: 10.1136/bmjopen-2019-031118.

Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?

Prism Schneider  1 , Richard Bransford  2 , Edward Harvey  3 , Julie Agel  4
Affiliations
Comparative Study

Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?

Prism Schneider et al. BMJ Open. .

Abstract

Objectives: To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures.

Design: Retrospective cohort study.

Setting: Two level 1 trauma centres.

Participants: Displaced midshaft clavicle fractures.

Results: 686 patients met inclusion criteria. The pretrial cohort (n=108) was 68.5% male, with a mean age of 37.7 (±13.9) years. The post-trial cohort (n=578) was 76.1% male, with a mean age of 41.9 (±12.7) years. There was nearly a 10-fold increase in the patients treated with openreduction and internal fixation (ORIF) in the post-trial cohort (34.1%) compared with the pretrial cohort (3.7%) (p<0.001). Patients in the post-trial cohort were more likely to undergo ORIF if they were <40 years (OR=2.2; 95% CI 1.53 to 3.10), if their Injury Severity Score was >9 (OR=1.6; 95% CI 0.89 to 2.99) or if they were treated at a centre that participated in the Canadian Orthopaedic Trauma Society (COTS) trial (OR=5.2; 95% CI 3.31 to 8.21).

Conclusions: This study demonstrated a significant shift towards more frequent ORIF for displaced midshaft clavicle fractures following the COTS trial. Quantifying changes in practice pattern following publication of level 1 evidence is important to further our understanding of the impact large randomisedclinical trails are having on clinical practice.

Keywords: clavicle fracture; evidence-based guidelines; practice patterns.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study consort diagram.
Figure 2
Figure 2
Number of referrals by year and percentage treated by open reduction and internal fixation (ORIF). Grey line indicates pretrial cohort versus post-trial cohort.
See this image and copyright information in PMC

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