NON-MODIFIABLE RISK FACTORS: AGE AND SEX

In general, non-modifiable factors and their effect on functional outcome after clavicle facture is not well studied. The effect of non-modifiable factors like age, gender, poly trauma, fall height, and hand dominance, fracture of shortening, and fracture displacement has been reported in the literature but no difference in functional outcome in these studied factors has been found.

One study reported no difference in outcomes based on age, sex, fracture type, and fracture shortening or displacement (Ban 2021). They reported better Constant scores at 6 weeks but no differences at 1 year. Another study did not find any differences in outcomes based on non-modifiable factors including age, sex, fracture shortening, hand dominance, or the diagnosis of diabetes (Chu 2018). Some studies reported no difference in outcome based on sex with either operative or non-operative treatment (Napora 2016, 2018). Finally, one study investigated high vs low energy mechanism, fall from height and the effect of hand dominance on clinical outcomes and found no difference (Nicholson 2020).

Benefits/Harms of Implementation

Nonmodifiable factors do not seem to affect patient reported outcomes therefore there is no significant benefit or harm of this recommendation.

Outcome Importance

Outcome does not go against standard of care. Surgical treatment of clavicle fracture is the preferred treatment in majority of significantly displaced fractures. Non-operative management could be a reasonable option in high-risk patients.

Cost Effectiveness/Resource Utilization

This recommendation does not have any effect on the financial aspect of clavicle fracture treatment.

Acceptability

Fracture treatment should be acceptable as it does not change the current standard of care.

Feasibility

Operative and non-operative treatment are feasible. There is no additional barrier as a result of this recommendation.

Future Research

Research is lacking in this field. As non-modifiable factors cannot be changed, treatment methods should be calibrated based on relevant factors to achieve better outcomes. Well powered randomized controlled studies to identify factors that negatively impact functional outcomes are needed to help surgeons select an appropriate treatment strategy.