Abstract

Displaced mid-shaft clavicle fractures have traditionally been treated non-operatively. New evidence supports the use of operative treatment with better functional results although with some risk of adverse complications. The patient's opinion in choosing one or the other option of treatment is important especially when a new therapeutic philosophy is introduced.

We aimed to obtain the patients' preference based on their opinion of various possible outcomes of each treatment method. A clinical decision tree was constructed based on probabilities for various outcomes from the current literature. We used clinical decision analysis based on Bayesian logic. A similar clinical decision analysis was done for a cohort of orthopaedic surgeons.

We interviewed 20 patients to obtain their health preferences on a numerical rating scale for each of the six possible outcomes for the conservative and operative treatments. Similar health preferences were obtained from 20 orthopaedic surgeons.

The cohort of patients were young (age range: 13 – 21, mean: 16 years) males involved in active sport. The results of the decision analysis demonstrated a strong preference for operative management in this cohort of patients (combined probability of 0.81 for operative treatment versus 0.61 for non-operative).

The cohort of orthopaedic surgeons were either career orthopaedic trainees or qualified orthopaedic surgeons with an age range of 28 – 41 years (mean age: 35 years). The results of the decision analysis demonstrated a weak preference for operative management in this cohort of surgeons (combined probability of 0.84 for operative treatment versus 0.77 for non-operative management).

Overall the young active patient is eight times more likely to prefer operative treatment over non-operative management compared to the well informed orthopaedic surgeon. Patient education is the key to a better informed patient who can make a balanced decision. Clinical decision analysis can be a useful tool in this process.