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· DOS Abstracts
Non-union of displaced midshaft fractures of the
clavicle: A predictor model using pain scores.
Andreas Qvist, Michael Toft Væsel, Carsten Moss, Thomas Jakobsen, Steen Lund
Jensen
Orthopedic surgery, Randers Regional Hospital; Orthopedic surgery, Viborg
Regional Hospital; Orthopedic surgery, Randers Regional Hospital; Orthopedic
surgery, Aalborg University Hospital; Orthopedic surgery, Aalborg University
Hospital
Background:
Surgical treatment of displaced midshaft fractures of the clavicle
reduces the risk of non-union, but provides no long-term benefits in functional
outcome scores. Treating all displaced fractures operatively with the purpose of
reducing non-union rates would lead to many unnecessary treatments (NNT=7).
Purpose / Aim of Study:
To identify early predictors for non-union in displaced
midshaft clavicular fractures and to develop a predictor model for non-union.
Materials and Methods:
We examined prospectively collected data on 64
non-operatively treated patients aged 18-60 years from a multicentre rand-
omized controlled trial. Odds ratios (OR) for various predictors were calculated
using logistic regression. For selected predictors we used receiver operating
characteristic (ROC) curve analysis to identify cut-off values for a predictor
model.
Findings / Results:
We identified 12 (19 %) patients with symptomatic non-
union. Failure to reduce pain VAS (pVAS) from week two to week four (OR
20.25, 95% CI 2.56 to 160.78, for no reduction in pain) and pVAS score at
week four (OR 2.28, 95% CI 1.4 to 3.6, for each point increase) were predictors
of non-union. ROC curve analysis identified a reduction in pVAS at 50 per cent
as the cut-off value to predict non-union. The area under the ROC curve was
0.84 (95% CI 0.70 to 0.93). The predictor model identifies 22 (34 %) patients
at high risk of developing non-union. In the high risk group 11 (50%) patients
developed non-union whereas only one patient (3 %) in the low risk group de-
veloped non-union (p<0.0001).
Conclusions:
It is possible to identify patients at high risk of non- union using
changes in pVAS score from week two to week four combined with pVAS score
at week four following a displaced midshaft fracture of the clavicle. This finding
could lead to a new treatment algorithm for midshaft clavicular fractures.
No conflicts of interest reported
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