Schairer William W, Nwachukwu Benedict U, Warren Russell F, Dines David M, Gulotta Lawrence V
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
J Orthop Trauma. 2017 Jun;31(6):e167-e172. doi: 10.1097/BOT.0000000000000820.
Clavicle fractures were traditionally treated conservatively, but recent evidence has shown improved outcomes with surgical management. The purpose of this study was to evaluate the recent trends in operative treatment of clavicle fractures, and to analyze for patient related factors that may affect treatment strategy.
The Healthcare Cost and Utilization Project (HCUP) California and Florida inpatient, outpatient, and the Emergency Department databases were used to identify all patients with clavicle fractures between 2005 and 2010. We evaluated the overall number of procedures over the study period and calculated the rates of operative and nonoperative treatment by tracking a large cohort of emergency department patients with clavicle fractures. Poisson and multivariable regression were used to identify trends and patient factors associated with treatment.
There was a 290% increase in the annual number clavicle fracture procedures over the study period. The rate of fixation increased from 3.7% to 11.1% (P < 0.001). Significant increases were seen in all patient age groups less than 65 years. Comparatively, higher rates of fixation were found in patients who were white, privately insured, and of high-income status. Lower income status was also associated with delayed surgery.
The rates of clavicle fracture fixation have increased. However, there are differences associated with socioeconomic factors including race, insurance type, and income level. In part, this likely representing both underutilization and overutilization but may also show differential access to care. This differential utilization suggests both that further work is needed to more clearly define indications for operative versus nonoperative management and to further evaluate referral systems and access to care to ensure equal and quality treatment is available for all patients.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
锁骨骨折传统上采用保守治疗，但最近的证据表明手术治疗效果更佳。本研究的目的是评估锁骨骨折手术治疗的近期趋势，并分析可能影响治疗策略的患者相关因素。
利用医疗成本与利用项目（HCUP）加利福尼亚州和佛罗里达州的住院、门诊及急诊科数据库，识别出2005年至2010年间所有锁骨骨折患者。我们评估了研究期间的手术总数，并通过追踪一大群急诊科锁骨骨折患者来计算手术和非手术治疗的比例。采用泊松回归和多变量回归来确定治疗趋势及相关患者因素。
在研究期间，每年锁骨骨折手术数量增加了290%。内固定率从3.7%升至11.1%（P<0.001）。所有65岁以下患者年龄组的内固定率均显著上升。相比之下，白人、有私人保险且收入高的患者内固定率更高。低收入状态也与手术延迟有关。
锁骨骨折内固定率有所上升。然而，存在与社会经济因素相关的差异，包括种族、保险类型和收入水平。这在一定程度上可能既代表利用不足和过度利用，也可能显示出获得医疗服务的差异。这种差异利用表明，需要进一步开展工作，以更明确地界定手术与非手术治疗的适应症，并进一步评估转诊系统和获得医疗服务的机会，以确保所有患者都能获得平等且优质的治疗。
预后水平III。有关证据水平的完整描述，请参阅作者指南。
