Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis

Putnam, Matthew D.; Vanderkarr, M.; Nandwani, P.; Holy, Chantal E.; Chitnis, A.S.

doi:10.1080/13696998.2019.1620245

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…A prior real-world US administrative claims database analysis conducted by our research group [23] found that the rate of clavicle fracture fixation was higher among US patients with commercial insurance compared to that observed in this current study (15.2 vs. 3.2%), albeit these two studies include very different populations in different geographies. In regard to complications associated with clavicle fracture fixation, this study compares as following to the US study: the rate of infection was lower in the US study (1.0 vs. 3.5%), the rate of non-union was similar (4.2 vs. 4.4%), and the rate of malunion was higher (0.9 vs. 0.3%).…”

Section: Discussioncontrasting

confidence: 76%

“…The clinical and economic burden of clavicle fractures is not well characterized. A prior analysis of US commercial insurance claim data evaluated 95,243 patients with clavicle fractures and found that 15.2% underwent surgical repair [23]. Among the patients undergoing surgery for clavicle fracture, 2-year rates of infection, non-union, and mal-union were low (1.0, 4.2, and 0.9%, respectively); however, the rate of reoperation was high due to device removal procedures [23].…”

Section: Introductionmentioning

confidence: 99%

“…A prior analysis of US commercial insurance claim data evaluated 95,243 patients with clavicle fractures and found that 15.2% underwent surgical repair [23]. Among the patients undergoing surgery for clavicle fracture, 2-year rates of infection, non-union, and mal-union were low (1.0, 4.2, and 0.9%, respectively); however, the rate of reoperation was high due to device removal procedures [23]. The objective of the current study is therefore to evaluate rates of surgical treatment, reoperations, post-surgical complications (i.e., infection, non-union, and malunion), reoperations and costs of reoperations in patients with clavicle fractures requiring surgery in England.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

Wolf

Chitnis

Manoranjith³

et al. 2022

BMC Musculoskelet Disord

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Introduction The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database. Methods CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010–2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery. Results 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)—84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156). Conclusions Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.

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Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

Wolf

Chitnis

Manoranjith³

et al. 2022

BMC Musculoskelet Disord

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“…ORIF is the preferred choice for treatment of clavicle fractures [ 4 ]. According to previous literature reports, some patients will experience complications such as fracture malunion, vascular injury, thoracic outlet syndrome, and pneumothorax, but brachial plexus injury is extremely rare [ 5 – 8 ]. Our team recently completed a case of a patient with a clavicle fracture, who developed symptoms of brachial plexus injury after surgery.…”

Section: Introductionmentioning

confidence: 99%

Brachial plexus injury after clavicle fracture operation: a case report and literature review

Cao

Hou

et al. 2021

BMC Surg

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Background Open reduction and internal fixation (ORIF) is the preferred choice for treating clavicle fractures. The brachial plexus injury caused by ORIF of a clavicle fracture is very rare. If it is not treated in time, the function of the brachial plexus will be challenging to recover, which will eventually lead to upper limb dysfunction and seriously affect the patient’s quality of life. Our team recently used ORIF to treat a patient with a clavicle fracture, who developed brachial plexus injury symptoms after surgery. Case presentation A 34-year-old female patient was admitted to the hospital for 13 h due to the right shoulder movement restriction after a fall. Due to the significant displacement of the fracture, we used ORIF to treat the fracture. The surgery went well. When the anaesthesia effect subsided 12 h after the operation, the patient developed right brachial plexus injury symptoms, decreased right upper limb muscle strength, dysfunction, and hypoesthesia. Symptomatic treatments, such as nourishing nerve and electrical stimulation, were given immediately. Sixty days after the operation, the patient’s brachial plexus injury symptoms disappeared, and the function of the right upper limb returned to the preoperative state. Conclusions Patients with clavicle fractures usually need to undergo a careful physical examination before surgery to determine whether symptoms of brachial plexus injury have occurred. Anaesthesia puncture requires ultrasound guidance to avoid direct damage to the brachial plexus. When the fracture end is sharp, reset should be careful to prevent nerve stump stabbed. When using an electric drill to drill holes, a depth limiter should be installed in advance to prevent the drill from damaging the subclavian nerve and blood vessels. When measuring the screw depth, the measuring instrument should be close to the bone surface and sink slowly to avoid intense hooks and damage to the brachial plexus. Try to avoid unipolar electrosurgical units to prevent heat conduction from damaging nerves, and bipolar electrocoagulation should be used instead. If symptoms of brachial plexus injury occur after surgery, initial symptomatic treatment is drugs and functional exercise, and if necessary, perform surgical exploration.

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“… 22 Implant prominence and soft-tissue irritation can also influence the need for subsequent implant removal. 17 , 21 A number of morphometrical studies have been able to quantify the anatomic variability of clavicle shape and topography. 1 , 2 , 3 , 4 , 5 , 10 , 11 , 15 , 24 Shape characteristics include the clavicle length (CL), volume, medial and lateral curves, and clavicular bow.…”

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confidence: 99%

The variance of clavicular surface morphology is predictable: an analysis of dependent and independent metadata variables

Fontana¹,

Hoyen²,

Blauth³

et al. 2020

JSES International

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Background The anatomy of the clavicle is specific and varied in reference to its topography and shape. These anatomic characteristics play an important role in the open treatment of clavicle fractures. The complex and variable topography creates challenges for implant placement, contouring, and position. Hardware prominence and irritation does influence the decision for secondary surgical intervention. Methods Computerized tomographic scans of 350 adult clavicles with the corresponding patients' metadata were acquired and digitized. Morphologic parameters determining the shape of the clavicle were defined and computed for each digitized bone. The extracted morphologic parameters were correlated with patient metadata to analyze the relationship between morphologic variability and patient characteristics. Results The morphologic parameters defining the shape, that is, the radius of the medial and lateral curves, the apparent clavicle height and width, and the clavicle bow position, correlate with the clavicle length. The clavicle length correlates with the patients' height. Gender differences in shape and form were dependent and related to individual height distribution and clavicle length. Asian populations showed a similarly predictable, but shifted, correlation between shape and clavicle length. Conclusion This anatomic analysis shows that the clavicle shape can be predicted through the clavicle length and patients' stature. Smaller patients have shorter and more curved clavicles, whereas taller patients have longer and less curved clavicles. This correlation will aid surgeons in fracture reduction, implant curvature selection, and in optimal adaptation of clavicle implants, and represents the basis for anatomically accurate solutions for clavicle osteosynthesis.

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Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis

Cited by 8 publications

References 28 publications

Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

Brachial plexus injury after clavicle fracture operation: a case report and literature review

The variance of clavicular surface morphology is predictable: an analysis of dependent and independent metadata variables

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