Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study.

BACKGROUND: Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. METHODS: Data were retrieved from the SFR on all clavicle fractures sustained by patients ≥ 15 years of age in 2013-2014 (n = 2 422) with regards to date of injury, cause of injury, fracture classification and treatment. RESULTS: Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 15-24 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. CONCLUSION: The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

Surgical and non-surgical treatment for fully displaced lateral clavicle fractures have similar outcomes: An observational register study of 113 patients.

INTRODUCTION: Whether displaced lateral clavicle fractures should be treated surgically remains controversial. This study aims to compare outcomes after surgical versus non-surgical treatment of such fractures. PATIENTS AND METHODS: 113 patients with lateral clavicle fractures registered in the Swedish Fracture Register (SFR) during 2018 and with complete displacement on radiography were included in this cohort study. Linkage with the National Patient Register provided information on baseline medical comorbidities and further interventions. Patient-reported outcome measures (PROM) were assessed using the European Quality of Life Scale (EQ-5D-3L), the Short Musculoskeletal Function Assessment (SMFA), and the Quick Disabilities of the Arm, Shoulder and Hand (QDASH). The primary outcome was the total number of initial and delayed surgical procedures. The secondary outcome was difference in PROM between surgically and non-surgically treated patient groups. RESULTS: At a mean follow-up of 4.4 (range 3.9-4.9) years, 35 (67 %) of the 52 patients initially treated surgically had undergone a secondary procedure, mostly for implant removal. Of the 61 initially non-surgically treated patients, 3 (5 %) underwent delayed surgical treatment due to non- or malunion. 45 (40 %) patients responded to follow-up questionnaires, but no statistically significant differences were found in any PROM between groups. CONCLUSIONS: Two thirds of surgically treated patients with displaced lateral clavicle fractures underwent two procedures. The need for delayed surgical treatment in non-surgically treated patients was low and PROM was similar in both treatment groups. Nonsurgical treatment should be considered as an option to surgery for fully displaced lateral fractures of the clavicle more often.

Is the Robinson classification of clavicle fractures accurate enough within the setting of the Swedish Fracture Register?

INTRODUCTION: In the Swedish Fracture Register (SFR) clavicle fractures are classified according to the Robinson classification. This study aimed to evaluate the accuracy of the classification of clavicle fractures in the SFR. A secondary aim was to assess inter- and intraobserver agreement. MATERIALS AND METHODS: Clavicle fractures (n = 132) were randomly selected from the SFR and radiographs were requested for each patient from their treating departments. Not all radiographs could be acquired, and after exclusion, 115 fractures were independently classified by three expert raters blinded to patient information. The 115 fractures were classified on two occasions, 3 months apart. The raters' consensus classification was used as a gold standard that was compared to the classification registered in the SFR. The accuracy, defined as the degree of agreement between the gold standard and SFR classifications, was reported, as was the inter- and intraobserver agreement for the expert raters. RESULTS: Agreement between the classification in the SFR and the gold standard classification was fair (kappa = 0.35). Fractures with only partial displacement were often incorrectly classified as fully displaced in the SFR (n = 31 of 78 displaced fractures in the SFR). The inter- and intraobserver agreement among the expert raters was almost perfect (interobserver kappa = 0.81-0.87, intraobserver kappa = 0.84-0.94). CONCLUSIONS: The accuracy of the classification of clavicle fractures in the SFR was only fair, whereas the inter- and intraobserver agreement among the expert raters was almost perfect. Accuracy in the SFR may be improved if the classification instructions in the SFR are updated by incorporating the original classification displacement criteria, both in text and in illustrated form.

Surgical Versus Nonsurgical Treatment of Lateral Clavicle Fractures: A Short-Term Follow-Up of Treatment and Complications in 122 Patients.

OBJECTIVES: To assess the total number of procedures in initially surgically and nonsurgically treated patients with lateral clavicle fractures and to compare patient-reported outcome measures (PROMs). DESIGN: Retrospective cohort study. SETTING: Level 1 trauma center. PATIENTS: One hundred twenty-two patients with lateral clavicle fractures treated at Uppsala University Hospital from 2013 to 2015 were included in a patient record review. A subgroup of 30 patients was assessed at a study follow-up visit at a median of 3 years postinjury. INTERVENTION: Comparisons between initially surgically and nonsurgically treated patients. MAIN OUTCOME MEASUREMENTS: Rates of surgical treatment, reoperations, and delayed surgeries. PROM subgroup: Constant score; Disabilities of the Arm, Shoulder and Hand score; and Visual Analog Scale over satisfaction with the cosmetic results and interview-based information on subjective complaints and reflections. RESULTS: Of 23 surgically treated patients (22 Neer type II and V fractures), 10 underwent subsequent implant removal, after which 1 developed symptomatic nonunion. Of 99 nonsurgically treated patients (36 Neer type II and V fractures), 2 underwent delayed surgery because of symptomatic nonunion. In the PROM subgroup, the surgically treated patients had worse Constant scores, complained of infraclavicular sensory deficits, and were less satisfied with the cosmetic result than the nonsurgically treated patients. CONCLUSIONS: Half of the surgically treated patients underwent implant removal, whereas delayed surgeries in nonsurgically treated patients were very rare. Nonsurgical treatment should be considered more often as an alternative to surgery even for the usually surgically treated Neer type II and V lateral clavicle fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.