TY - JOUR
T1 - In patients with combined clavicle and multiple rib fractures, does fracture fixation of the clavicle improve clinical outcomes? A multicenter prospective cohort study of 232 patients
AU - Hoepelman, Ruben J.
AU - Van Der Linde, Rens A.
AU - Beeres, Frank J.P.
AU - Beks, Reinier B.
AU - Sweet, Arthur A.R.
AU - Lansink, Koen W.W.
AU - Van Wageningen, Bas
AU - Tromp, Tjarda N.
AU - Minervini, Fabrizio
AU - Link, Björn Christian
AU - Van Veelen, Nicole M.
AU - Hoogendoorn, Jochem M.
AU - De Jong, Mirjam B.
AU - Van Baal, Mark C.P.
AU - Leenen, Luke P.H.
AU - Groenwold, Rolf H.H.
AU - Houwert, Roderick M.
AU - Ijpma, Frank F.
N1 - Funding Information:
This work was part of the activities of the Natural Experiments Study Group ( www.NEXT-studygroup.org ). This work was financially supported by the DePuy Synthes (grant number DPS-TCMF-2017-036). The organization was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All researchers are independent from the funder. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. DISCLOSURE
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - BACKGROUND Clavicle and rib fractures are often sustained concomitantly. The combination of injuries may result in decreased stability of the chest wall, making these patients prone to (respiratory) complications and prolonged hospitalization. This study aimed to assess whether adding chest wall stability by performing clavicle fixation improves clinical outcomes in patients with concurrent clavicle and rib fractures. METHODS A prospective multicenter study was performed including all adult patients admitted between January 2018 and March 2021 with concurrent ipsilateral clavicle and rib fractures. Patients treated operatively versus nonoperatively for their clavicle fracture were matched using propensity score matching. The primary outcome was hospital length of stay (HLOS). Secondary outcomes were intensive care unit length of stay, duration of mechanical ventilation, pain, complications, and quality of life at 6 weeks and 12 months of follow-up. RESULTS In total, 232 patients with concomitant ipsilateral clavicle and rib fractures were included. Fifty-two patients (22%) underwent operative treatment of which 39 could be adequately matched to 39 nonoperatively treated patients. No association was observed between clavicle plate fixation and HLOS (mean difference, 2.3 days; 95% confidence interval, -2.1 to 6.8; p = 0.301) or any secondary endpoint. Eight of the 180 nonoperatively treated patients (4%) had a symptomatic nonunion, for which 5 underwent secondary clavicle fixation. CONCLUSION We found no evidence that, in patients with combined clavicle and multiple rib fractures, plate fixation of the clavicle reduces HLOS, pain, or (pulmonary) complications, nor that it improves quality of life. STUDY TYPE Therapeutic/Care Management; Level III.
AB - BACKGROUND Clavicle and rib fractures are often sustained concomitantly. The combination of injuries may result in decreased stability of the chest wall, making these patients prone to (respiratory) complications and prolonged hospitalization. This study aimed to assess whether adding chest wall stability by performing clavicle fixation improves clinical outcomes in patients with concurrent clavicle and rib fractures. METHODS A prospective multicenter study was performed including all adult patients admitted between January 2018 and March 2021 with concurrent ipsilateral clavicle and rib fractures. Patients treated operatively versus nonoperatively for their clavicle fracture were matched using propensity score matching. The primary outcome was hospital length of stay (HLOS). Secondary outcomes were intensive care unit length of stay, duration of mechanical ventilation, pain, complications, and quality of life at 6 weeks and 12 months of follow-up. RESULTS In total, 232 patients with concomitant ipsilateral clavicle and rib fractures were included. Fifty-two patients (22%) underwent operative treatment of which 39 could be adequately matched to 39 nonoperatively treated patients. No association was observed between clavicle plate fixation and HLOS (mean difference, 2.3 days; 95% confidence interval, -2.1 to 6.8; p = 0.301) or any secondary endpoint. Eight of the 180 nonoperatively treated patients (4%) had a symptomatic nonunion, for which 5 underwent secondary clavicle fixation. CONCLUSION We found no evidence that, in patients with combined clavicle and multiple rib fractures, plate fixation of the clavicle reduces HLOS, pain, or (pulmonary) complications, nor that it improves quality of life. STUDY TYPE Therapeutic/Care Management; Level III.
KW - clavicle fracture
KW - combined clavicle and rib fractures
KW - costoclavicular fractures
KW - Rib fracture
UR - https://www.scopus.com/pages/publications/85165793741
U2 - 10.1097/TA.0000000000004001
DO - 10.1097/TA.0000000000004001
M3 - Article
C2 - 37165478
AN - SCOPUS:85165793741
SN - 2163-0755
VL - 95
SP - 249
EP - 255
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -