Increasing Trends Towards Surgical Fixation of Displaced Midshaft Clavicle Fractures

Objectives This study analyzes trends concerning rates of surgical repair with open reduction and internal fixation (ORIF) for displaced midshaft clavicle fractures. It better defines the relationships between these demographic factors and the decision for operative intervention for displaced midshaft clavicle fractures. The study hypothesis was that displaced midshaft clavicle fractures are being treated more frequently with surgical repair and that significant associations would be seen between the rates of surgical intervention and demographic factors such as age, sex, race, and ethnicity. Methods A retrospective analysis was conducted using data from the TriNetX US Collaborative Network, encompassing 68,301 patients diagnosed with displaced midshaft clavicle fractures between 2017 and 2022. Patients were categorized into surgical and non-surgical groups based on current procedure terminology (CPT) codes. Statistical analyses, including the Cochran-Armitage Test and calculation of odds ratios with 95% confidence intervals, were performed to identify associations between demographic variables and ORIF rates. Results The study found a significant increase in ORIF rates, from 12.8% in 2017 to 14.9% in 2022 (P < 0.001). Younger age was a significant factor for ORIF likelihood, with individuals 18-64 most represented. Male sex is associated with higher rates of operative management than female sex (odds ratio (OR)=1.5, 95% confidence interval (CI)=2.03-2.26). Notably, racial disparities were evident, with Black, Native American, and Pacific Islander patients significantly associated with lower ORIF rates compared to White individuals (P<0.05). Hispanics were also associated with lower surgical management rates compared to non-Hispanics (P<0.05). Conclusion A trend in increasing ORIF rates reflects a shift toward more aggressive treatment of clavicle fractures, particularly among younger and male patients. However, the pronounced racial disparities, particularly the lower rates of ORIF among minority patients, underscore the need for targeted interventions to address these inequities.