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Use nonunion probability to counsel patients with displaced clavicle fractures
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Among patients aged 18 years or older, smoking was the biggest risk factor for displaced diaphyseal clavicle fractures that do not heal, findings of a recent study showed.
“Thirteen percent of displaced diaphyseal fractures in patients who were at least 18 years of age did not heal,” the authors wrote. “Smoking was the strongest risk factor.”
The researchers, who are from Scotland, included patients at least 18 years of age who had fractures in the middle three-fifths of the clavicle and complete displacement of the main fragments with no cortical contact who underwent initial nonoperative treatment. Demographics and radiographic results also needed to be documented. This resulted in 941 patients aged 36.8 years, mean, who were followed from January 1994 to December 2007 until the fractures reached union or nonunion.
The top risk factors found for nonunion were smoking with an odds ratio of 3.76, comminution with an odds ratio of 1.75 and fracture displacement with an odds ratio of 1.17.
If all fractures had been managed operatively, the researchers determined they would need to perform 7.5 operations to prevent a “single” nonunion and had they operated only on patients with a ≥40% nonunion probability, they found they would need to perform 1.5 operations to prevent a nonunion.
“We believe the predicted probability of nonunion should be used to guide clinicians in counseling patients, rather than to apply an arbitrary threshold of risk to determine the management strategy,” the authors concluded.
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