Abstract
Abstract
Background
Distal third clavicle (DTC) fractures represent 2.6 to 4% of all adult fractures but there is no consensus as to the surgical management of these injuries. The primary outcomes of this study were to determine the frequency of DTC fractures and their management. Secondary outcomes included complications, further procedures, fracture union and the breakdown of treatment by modified Neer classification.
Methods
A multicentre cohort study was conducted between 1st January 2019–31st December 2019. All patients, over 18 years old, with an isolated DTC fracture were included. Demographic variables, management, mechanism of injury, modified Neer classification and fracture union were recorded. Simple statistical analysis was performed as a total dataset and as a breakdown of major trauma centres (MTCs) vs trauma units (TUs).
Results
859 patients from 18 different NHS trusts (15 TUs and 3 MTCs) were included. The mean age was 57 years (18 to 99). 87% were treated conservatively and 54% were Neer type 1 fractures. With regards to operative management, 89% of patients who underwent an operation were under the age of 60. 56% of patients had evidence of union at most recent follow-up.
Conclusions
This is the first and largest epidemiological review of DTC fractures in the UK. Results show that younger patients, suffering higher mechanism of injury, are more likely to undergo surgery. Furthermore, rates of union are low but further research is needed to determine the functional outcomes of these patients. There is scope for a pragmatic RCT for the treatment of DTC.
