Union accurately predicted with delayed assessment 6 weeks after displaced midshaft clavicle fracture
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Accurate prediction of union with nonoperative management for a displaced midshaft clavicle fracture was seen with delayed assessment at 6 weeks after injury, according to study results.
In a prospective study, researchers identified 200 patients who sustained a displaced midshaft clavicle fracture. Investigators assessed demographic characteristics, injury factors, functional scores and radiographic predictors at 6 weeks. Factors that independently predicted nonunion at 6 months after injury determined with CT were identified with conditional stepwise regression modeling. Based on smoking status, comminution and fracture displacement, the nonunion predictor 6-week model was compared with a model that was previously validated.
Results showed the CT-defined nonunion rate was 14%. Investigators noted the greatest accuracy on receiver operator characteristic (ROC) curve analysis with the QuickDASH scores, with a 39.8-point threshold. This correlated with nonunion. At 6 weeks, 69% of patients had a QuickDASH score of less than 40 points. Of these patients, 90% had fracture nonunion. Significant predictors of nonunion included a QuickDASH score of 40 points or more, no callus formation on radiographs and fracture movement on examination.
If there were no predictors present, the predicted nonunion risk was 3%, which was found in 40% of patients. If there were two or more predictors seen, which was found in 23.5% of patients, the predicted nonunion risk was 60%. Superior accuracy was seen for fracture healing on the ROC curve analysis in the nonunion predictor model at 6 weeks compared with the model at the time of injury. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
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Nicholson JA, et al. J Bone Joint Surg Am. 2020;doi: 10.2106/JBJS.19.00955.
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