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

Abstract

To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures. Retrospective cohort study. Two level 1 trauma centres. Displaced midshaft clavicle fractures. 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 <i>Canadian Orthopaedic Trauma Society (</i><i>COTS</i><i>)</i> trial (OR=5.2; 95% CI 3.31 to 8.21). This study demonstrated a significant shift towards more frequent <i>ORIF</i> 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 <i>randomised</i><i>clinical trails</i> are having on clinical practice.