PATIENT SATISFACTION WITH POSTOPERATIVE SCAR FOLLOWING SURGICAL FIXATION OF MID-DIAPHYSEAL CLAVICLE FRACTURES

Open reduction and internal fixation (ORIF) of displaced mid-diaphyseal clavicle fractures is associated with higher union rates, lower malunion rates, and earlier functional recovery. Since the randomized clinical trial performed by the Canadian Orthopaedic Trauma Society, there has been a nearly 10-fold increase in ORIF for mid-diaphyseal clavicle fractures reported. While a common question from patients, post-surgical scar satisfaction has not been assessed; therefore, this study aimed to evaluate patient satisfaction using the Patient and Observer Scar Assessment Scale (POSAS) for the first time. This is a multi-centre, prospective cohort study of patients 18 years or older who underwent mid-diaphyseal clavicle fracture ORIF. Participants were followed serially until 1-year. Scar satisfaction was evaluated using the validated POSAS scale, which is comprised of a patient scale (pain, itch, thickness, colour, stiffness, and irregularity), and an observer scale (vascularity, pigmentation, texture, thickness, pliability, and surface area). Overall satisfaction scores were collected at each follow-up from the patient and the observer using a 10-point Likert scale. Pain was assessed using a 100-point Likert scale for current pain level. Descriptive statistics were used, with Chi square and Mann-Whitney U tests for between group comparisons, and a Wilcoxon signed rank test was used to compare paired data between 2-week and 3-month follow-up. A total of 89 patients were recruited between June 2022 and September 2024 across three participating centres, with a median age of 35 (IQR = 26, 48) years and 83.1% being male. There were 41 (46.1%) treated with single plate and screw constructs and 47 (52.8%) treated with dual plate and screw constructs. There was no difference in age (p = 0.93), sex (p = 0.15), or body mass index (BMI; p = 0.41) between those treated with single plate or dual plate fixation. At the 3-month follow-up, the median scar length was 115.0 (IQR = 100.0, 130.0) mm, the median scar width was 3.0 (IQR = 2.0, 5.0) mm, and the median scar height was 0.0 (IQR = 0.0, 0.0) mm. The median POSAS for the patient scale (combined score) at two weeks was 18.0 (IQR = 13.0, 29.8), and significantly improved to 10.0 (IQR = 7.25, 16.0) at three months (p The mean POSAS for the observer scale (combined score) at two weeks was 23.0 (IQR = 14.5, 29.0), and also significantly improved to 16.0 (IQR = 11.0, 20.5) at three months (p = 0.001). The patient-reported pain visual analogue scale improved from a median score of 10.0 (IQR = 2.0, 20.5) at the 2-week follow-up to 4.0 (IQR = 0.0, 9.0) at three months (p Figure 1: Patient-reported scar assessment at 2-week follow-up indicting poorer satisfaction for A (score = 37) compared with greater satisfaction for B (score = 15). This study provides novel data to support a significant improvement in patient satisfaction with their scar, as well as pain, by three months post-operatively. This can be used to help inform discussions regarding recovery. For any figures or tables, please contact authors directly.