Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?
BMJ Open
; 9(9): e031118, 2019 09 04.
Article
en En
| MEDLINE
| ID: mdl-31488493
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Pautas de la Práctica en Medicina
/
Clavícula
/
Fracturas Óseas
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Reducción Abierta
/
Fijación Interna de Fracturas
Tipo de estudio:
Observational_studies
/
Prognostic_studies
Límite:
Adult
/
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
BMJ Open
Año:
2019
Tipo del documento:
Article
País de afiliación:
Canadá