Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions

Factors Associated With Surgical Treatment of Isolated, Displaced Midshaft Clavicle Fractures

Given the current available evidence, surgical treatment of isolated, displaced midshaft clavicle fractures is discretionary. The aim of this study was to determine whether there are identifiable factors associated with the surgical treatment of isolated, displaced midshaft clavicle fractures. A retrospective cohort study of 150 patients who underwent nonoperative treatment and 290 patients who underwent surgical treatment of isolated, displaced midshaft clavicle fractures from January 2010 to March 2019 at 2 level I trauma centers was performed. Multivariable regression analysis demonstrated that younger age (odds ratio [OR], 0.97; 95% CI, 0.95-0.99), absence of diabetes mellitus (OR, 0.045; 95% CI, 0.003-0.79), nonsmoking status (OR, 0.31; 95% CI, 0.13-0.75), higher American Society of Anesthesiologists classification (OR, 5.0; 95% CI, 2.7-9.2), fracture comminution (OR, 2.3; 95% CI, 1.3-3.9), and fracture displacement (OR, 1.1; 95% CI, 1.0-1.1) were associated with surgical treatment of an isolated, displaced midshaft clavicle fracture. Furthermore, lower social deprivation (OR, 0.99; 95% CI, 0.97-0.99) and private insurance compared with Medicare (OR, 6.6; 95% CI, 1.6-27) were associated with surgical treatment. The authors conclude that surgical treatment of discretionary midshaft clavicle fractures is influenced by patient factors, fracture characteristics, and socioeconomic factors. Further study is needed to understand the etiology of social disparities in clavicle surgery and rectify unintended trends in treatment. [Orthopedics. 2021;44(4):e515-e520.].

Factors Associated With Surgical Treatment of Nondisplaced or Minimally Displaced Scaphoid Waist Fractures

PURPOSE

To determine whether there are identifiable factors associated with the surgical treatment of nondisplaced or minimally displaced scaphoid waist fractures.

METHODS

We identified 50 patients who underwent nonsurgical treatment and 67 patients who underwent surgical treatment of nondisplaced or minimally displaced scaphoid waist fractures at 2 tertiary care referral centers in a single metropolitan area in the United States between January 2010 and March 2019. Bivariate analysis was used to screen for factors associated with surgical treatment. Multivariable stepwise logistic regression was used to determine factors associated with surgical treatment of a nondisplaced or minimally displaced scaphoid fracture.

RESULTS

Multivariable logistic regression analysis showed that male sex (odds ratio = 2.80; 95% confidence interval, 1.20-6.52) and employed status (odds ratio = 3.12, 95% confidence interval, 1.24-7.85) were associated with surgical treatment of nondisplaced or minimally displaced scaphoid waist fractures.

CONCLUSIONS

Male and employed patients have increased odds of undergoing scaphoid surgery for nondisplaced or minimally displaced waist fractures compared with female and unemployed patients. These differences may represent patient preference, surgeon counseling, or a combination. Further study is needed to understand the etiology of this sex difference.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.