Current clinical practice among orthopedic surgeons in Australia for treatment of midshaft clavicle fractures.

Abstract

Controversy remains regarding the optimal management of midshaft clavicle fractures, and thus, no clear treatment guide exists for clinicians. This study aimed to identify the current clinical practice among Australian orthopedic surgeons in the treatment of midshaft clavicle fractures and the clinical, patient, and radiological parameters that influence a clinician's decision making. This study further aimed to compare current Australian clinical practice with clinical practices internationally. A nationwide online questionnaire containing 5 case vignettes of midshaft clavicle fractures (randomized from a bank of 50 case vignettes) was distributed to orthopedic surgeons in Australia. Data on treatment preference and surgeon background were collected to ascertain parameters influencing surgical vs. nonsurgical management decision. Nonsurgical management was elected by orthopedic surgeons within Australia in 53% of responses. Poor consensus was observed with only 36% of cases having agreement of at least 75% of surgeons regarding surgical vs. nonsurgical management. Factors identified as independently contributing to recommending surgery over nonsurgical treatment were being a shoulder surgeon (odds ratio [OR] = 2.00 [95% confidence interval [CI]: 1.37-2.84]), presence of clinical deformity (OR = 3.15 [95% CI: 2.00-5.04]), presence of fracture shortening (OR = 1.61 [95% CI: 1.07-2.46]), and patients having a preference for surgery (OR = 3.18 [95% CI: 1.85-5.57]). Patient age, hand dominance, and smoking history were not significantly associated with the management decision. Considerable disagreement between surgeons exists regarding recommendation for surgery for midshaft clavicle fractures. Surgical decision making was influenced by surgeon factors, fracture factors, and patient preference.