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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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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| author | Julie Agel Edward Harvey Prism Schneider Richard Bransford |
| author_facet | Julie Agel Edward Harvey Prism Schneider Richard Bransford |
| author_sort | Julie Agel |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-2f1fcc3b771e4007b8e4bb2b782dfdcd |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-2f1fcc3b771e4007b8e4bb2b782dfdcd2025-08-20T02:07:12ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-031118Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?Julie Agel0Edward Harvey1Prism Schneider2Richard Bransford3University Of Minnesota, Minneapolis, USADepartment of Surgery, McGill University, Montreal, Québec, Canada1 Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada2 Orthopaedics, Harborview Medical Center, Seattle, Washington, USAObjectives 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.https://bmjopen.bmj.com/content/9/9/e031118.full |
| spellingShingle | Julie Agel Edward Harvey Prism Schneider Richard Bransford Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? BMJ Open |
| title | Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? |
| title_full | Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? |
| title_fullStr | Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? |
| title_full_unstemmed | Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? |
| title_short | Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? |
| title_sort | operative treatment of displaced midshaft clavicle fractures has randomised control trial evidence changed practice patterns |
| url | https://bmjopen.bmj.com/content/9/9/e031118.full |
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