Mid-Third Clavicle Fractures: A Novel Pathway Identifying Patients Benefitting from Surgical Fixation

Description

In this presentation, Lalisa Bommireddy, a CT1 at Royal Derby Hospital, discusses the management pathway for mid-third clavicle fractures, which represent 75% of clavicle injuries. The management of such fractures is debated, with the Canadian Orthopedic Society advocating for operative fixation to prevent nonunion and improve functional outcomes, while others suggest conservative management followed by intervention if nonunion occurs.



The study comprises two parts: a retrospective cohort analysis and the implementation of a new management pathway, focusing on assessing clavicle shortening using the Matamora technique, which measures shortening as a percentage of overall length. A shortening greater than 15% is linked to scapular dyskinesia. Lalisa presents findings from a two-year analysis involving 141 patients, revealing a nonunion rate of 4% for patients with less than 15% shortening compared to 13% for those with more.



The new pathway aims to standardize management by identifying patients who may benefit from acute fixation, specifically those with significant shortening who face a higher risk of nonunion, demonstrated through a follow-up of six weeks. Lalisa outlines that if multiple nonunion risk factors are present, these patients are offered delayed fixation. The analysis of this pathway includes 37 prospective cases, showing no significant increase in fixation surgery post-pathway. Patients previously managed conservatively now experience improved outcomes and reduced clinic appointments, with a notable decrease in nonunion rates from 4% to 0%. Overall, the evidence supports that targeted fixation leads to reduced nonunion rates and enhanced recovery outcomes.

DOI: 10.1302/3114-221959

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