The role of patient and surgeon characteristics on the treatment decision for displaced midshaft clavicle fractures in athletes: a global survey
Background: Diaphyseal clavicle fractures are common in athletes. While surgery can reduce the risk of nonunion and expedite return to sport, it carries risks and may lead to hardware removal. How patient and surgeon characteristics influence treatment decisions in athletes with displaced midshaft clavicle fractures has not been clearly defined. Methods: Participants from the Science of Variation Group were invited to review randomized radiographs of displaced midshaft clavicle fractures paired with different patient scenarios that included age, sports level, dominant arm, type of sport, timing within the season, presence of an upcoming significant sporting event occurring within the next three months, and five distinct sets of radiographs. Surgeons rated their likelihood of offering surgery (scale: 0-100). Multivariable analysis identified factors associated with the likelihood of offering surgery. Data are presented as regression coefficients (RCs) with corresponding 95% confidence intervals (CIs). Statistical significance was set at P < .05. Analyses were conducted in STATA version 13. Results: A total of 94 surgeons reviewed 470 different clinical scenarios. Surgeons were primarily based in the United States (43%) and Europe (32%); 90% were male and 82% were involved in teaching trainees. The predominant specialty was orthopedic trauma surgery (40%), followed by hand/wrist surgery (28%) and shoulder/elbow surgery (14%). Compared with weekend athletes, surgeons were significantly more likely to offer surgery to professional athletes (RC = 14; CI = 7.8-20; P < .001), corresponding to a mean increase of 14 points on the 0-100 scale. The presence of an important upcoming sporting event was also associated with a higher likelihood of offering surgery (RC = 9.5; CI = 4.5-15; P < .001), corresponding to a mean increase of 9.5 points on the 0-100 scale. Male surgeons were more likely to offer surgery than female surgeons (RC = 16; CI = 4.1-26; P = .004), corresponding to 16 points higher on the 0-100 scale. This observed association should be interpreted with caution, given the limited number of female respondents. Conclusions: Surgical decision-making for displaced midshaft clavicle fractures in athletes is influenced not only by anatomical considerations but also by contextual factors directly related to functional recovery. Overall, the findings suggest that surgeons weigh functional demands and timing heavily when making these decisions, underscoring the importance of shared decision-making tailored to the individual athlete.
