Four low quality observational studies examined the impact of various factors on the rate of nonunion for non-operatively treated midshaft clavicle fractures. Two studies found that comminution and displacement had a significant impact increasing the rate of nonunion (Liu 2015, Robinson 2004). One study found that comminution predicted delays in union at 6 and 12 weeks, but not by 24 weeks (Robinson 2004). Finally, one study found that comminution did not impact union rates (Rugpolmuang 2016). Based on the available evidence it is likely that comminution and displacement increase the risk of nonunion of a non-operatively treated midshaft clavicle fracture.
Benefits/Harms of Implementation
Understanding predictors of nonunion will benefit patients by providing the surgeon with more predictive information to help guide treatment. This can help minimize treatment delays and inappropriate treatment for patients.
Outcome Importance
Understanding predictors of nonunion with non-operative treatment of clavicle fractures is critical to patient counseling and treatment decision making.
Cost Effectiveness/Resource Utilization
Understanding predictors of nonunion can help lead to optimizing treatment for a patient earlier to reduce time off work while balancing complications.
Acceptability
Surgeons are likely to accept that there may be a higher risk of nonunion based on certain fracture characteristics, although this clinical practice guideline is not making treatment recommendations.
Feasibility
Guidelines regarding risk provide surgeons with information to help counsel patients and guide treatment but no treatment recommendations are provided here.
Future Research
Further research regarding outcomes is needed so that surgeons can make treatment decisions based on the risk of nonunion.
- Robinson, C. M., Court-Brown, C. M., McQueen, M. M., Wakefield, A. E. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. Journal of Bone & Joint Surgery - American Volume 2004; 7: 1359-65
- Rugpolmuang, L., Harnroongroj, T., Sudjai, N., Harnroongroj, T. Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures. Acta Orthopaedica et Traumatologica Turcica 2016; 1: 32-6
- Liu, W., Xiao, J., Ji, F., Xie, Y., Hao, Y. Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures. Orthopaedics & traumatology, surgery & research 2015; 2: 197-200