LIMITED RECOMMENDATION Five low quality studies were examined, identifying smoking as the most common modifiable risk factor associated with poor outcomes (nonunion in surgical or non-surgical fixation). One study showed that non-union is an uncommon outcome in non-surgical treatment, however the risk of non-union was greatly increased by smoking (Liu 2015). Another non-surgical treatment study showed that smoking was the strongest risk factor for non-union (Murray 2013).
In two studies that analyzed both surgical and non-surgical treatment of clavicle fractures, ASES scores were assessed, demonstrating that smokers in each group had significantly lower ASES scores than those that did not smoke (Napora 2016, 2018). Smoking and unemployment led to overall poorer outcome in each of these studies as well. The final study also linked clavicle fracture non-union to smoking (Chu 2018).
Benefits/Harms of Implementation
Recognition of the risks of smoking on outcome following clavicle fracture may benefit surgeons as they counsel patients regarding expected outcomes.
Outcome Importance
Smoking is a modifiable risk factor that can be directly correlated to outcomes following a clavicle fracture which is critical to patient counseling and treatment decision making.
Cost Effectiveness/Resource Utilization
Not applicable to this recommendation.
Acceptability
No change to treatment is recommended.
Feasibility
As no change to treatment is recommended, feasibility is not applicable.
Future Research
Further research regarding other modifiable risk factors that may impact clavicle fracture treatment is needed.
- Liu, W., Xiao, J., Ji, F., Xie, Y., Hao, Y. Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures. Orthopaedics & traumatology, surgery & research 2015; 2: 197-200
- Napora, J. K., Grimberg, D., Childs, B. R., Vallier, H. A. Factors Affecting Functional Outcomes After Clavicle Fracture. Journal of the American Academy of Orthopaedic Surgeons 2016; 10: 721-7
- Napora, J. K., Grimberg, D. C., Childs, B. R., Vallier, H. A. Results and Outcomes After Midshaft Clavicle Fracture: Matched Pair Analysis of Operative Versus Nonoperative Management. Orthopedics 2018; 5: e689-e694
- Murray, I. R., Foster, C. J., Eros, A., Robinson, C. M. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. Journal of Bone & Joint Surgery - American Volume 2013; 13: 1153-8
- Chu, J. Y., Yeh, K. T., Lee, R. P., Yu, T. C., Chen, I. H., Peng, C. H., Liu, K. L., Wang, J. H., Wu, W. T. Open reduction and internal fixation with plating is beneficial in the early recovery stage for displaced midshaft clavicular fractures in patients aged 30-65 years old. Tzu Chi Medical Journal 2018; 4: 242-246