Wu Hao-Hua, Chopra Aman, Carrillo Laura A, Callahan Matt, Swarup Ishaan
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.
HSS J. 2022 Nov;18(4):535-540. doi: 10.1177/15563316211059101. Epub 2021 Dec 3.
It is not known if the adult literature on midshaft clavicle fracture treatment with open reduction internal fixation (ORIF) has influenced injury management in adolescents. : We sought to longitudinally evaluate the rates of operative management of adolescent midshaft clavicle fractures in the state of Florida. : We conducted a retrospective review of data from the following Healthcare Cost and Utilization Project databases: the State Inpatient Database, the State Ambulatory Surgery and Services Database, and the State Emergency Department Database. Patients in Florida ages 10 to 18 years with midshaft clavicle fractures between 2005 and 2014 were identified along with data on age, sex, race/ethnicity, insurance type, treatment, and income percentile. We reviewed the data to identify trends in the rates of operative management of midshaft clavicle fractures. We then compared the rates of operative management between the first 3 years and the most recent 3 years (2005-2007 vs 2012-2014). Various demographic and socioeconomic factors were compared between patients treated with and without surgery. Descriptive statistics as well as univariate and multivariate analyses were performed. : There were 4297 midshaft clavicle fractures in adolescents identified between 2005 and 2014, and 338 (7.8%) of these fractures underwent operative management. There was a significant increase in the rate of operative management; it increased from 4.3% (n = 59) of the 1373 clavicle fractures that occurred between 2005 and 2007 to 11.2% (n = 130) of the 1164 clavicle fractures that occurred between 2012 and 2014. Patients with commercial insurance and patients who were older were more likely to undergo ORIF. Patients with Medicaid were more likely to undergo ORIF between 2012 and 2014 compared with patients with Medicaid between 2005 and 2007. : Operative management rates of adolescent midshaft clavicle fractures have significantly increased in Florida over a decade; additional research is needed to understand these findings.
成人关于切开复位内固定（ORIF）治疗锁骨中段骨折的文献是否影响青少年损伤的处理尚不清楚。我们试图纵向评估佛罗里达州青少年锁骨中段骨折的手术治疗率。我们对以下医疗保健成本与利用项目数据库的数据进行了回顾性分析：州住院数据库、州门诊手术与服务数据库以及州急诊科数据库。确定了2005年至2014年间佛罗里达州年龄在10至18岁且患有锁骨中段骨折的患者，并获取了有关年龄、性别、种族/族裔、保险类型、治疗方式和收入百分位数的数据。我们审查数据以确定锁骨中段骨折手术治疗率的趋势。然后我们比较了前3年和最近3年（2005 - 2007年与2012 - 2014年）的手术治疗率。对接受手术和未接受手术治疗的患者的各种人口统计学和社会经济因素进行了比较。进行了描述性统计以及单因素和多因素分析。2005年至2014年间确定有4297例青少年锁骨中段骨折，其中338例（7.8%）接受了手术治疗。手术治疗率有显著增加；从2005年至2007年发生的1373例锁骨骨折中的4.3%（n = 59）增加到2012年至2014年发生的1164例锁骨骨折中的11.2%（n = 130）。拥有商业保险的患者和年龄较大的患者更有可能接受切开复位内固定。与2005年至2007年的医疗补助患者相比，2012年至2014年的医疗补助患者更有可能接受切开复位内固定。在佛罗里达州，十年来青少年锁骨中段骨折的手术治疗率显著增加；需要进一步研究以理解这些发现。
