Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?
Objectives To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures.Design Retrospective cohort study.Setting Two level 1 trauma centres.Participants Displaced midshaft clavicle fractures.Results 686 patient...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e031118.full |
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| Summary: | Objectives To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures.Design Retrospective cohort study.Setting Two level 1 trauma centres.Participants Displaced midshaft clavicle fractures.Results 686 patients met inclusion criteria. The pretrial cohort (n=108) was 68.5% male, with a mean age of 37.7 (±13.9) years. The post-trial cohort (n=578) was 76.1% male, with a mean age of 41.9 (±12.7) years. There was nearly a 10-fold increase in the patients treated with openreduction and internal fixation (ORIF) in the post-trial cohort (34.1%) compared with the pretrial cohort (3.7%) (p<0.001). Patients in the post-trial cohort were more likely to undergo ORIF if they were <40 years (OR=2.2; 95% CI 1.53 to 3.10), if their Injury Severity Score was >9 (OR=1.6; 95% CI 0.89 to 2.99) or if they were treated at a centre that participated in the Canadian Orthopaedic Trauma Society (COTS) trial (OR=5.2; 95% CI 3.31 to 8.21).Conclusions This study demonstrated a significant shift towards more frequent ORIF for displaced midshaft clavicle fractures following the COTS trial. Quantifying changes in practice pattern following publication of level 1 evidence is important to further our understanding of the impact large randomisedclinical trails are having on clinical practice. |
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| ISSN: | 2044-6055 |