PREDICTORS OF NON-UNION FOLLOWING NON-OPERATIVELY TREATED CLAVICLE FRACTURE
Increasing displacement and/or comminution in mid-shaft clavicle fractures may be associated with higher rates of non-union following non-operative treatment in adults.

Rationale

Four low quality observational studies examined the impact of various factors on the rate of nonunion for non-operatively treated midshaft clavicle fractures. Two studies found that comminution and displacement had a significant impact increasing the rate of nonunion (Liu 2015, Robinson 2004). One study found that comminution predicted delays in union at 6 and 12 weeks, but not by 24 weeks (Robinson 2004). Finally, one study found that comminution did not impact union rates (Rugpolmuang 2016). Based on the available evidence it is likely that comminution and displacement increase the risk of nonunion of a non-operatively treated midshaft clavicle fracture.

Benefits/Harms of Implementation

Understanding predictors of nonunion will benefit patients by providing the surgeon with more predictive information to help guide treatment. This can help minimize treatment delays and inappropriate treatment for patients.

Outcome Importance

Understanding predictors of nonunion with non-operative treatment of clavicle fractures is critical to patient counseling and treatment decision making.

Cost Effectiveness/Resource Utilization

Understanding predictors of nonunion can help lead to optimizing treatment for a patient earlier to reduce time off work while balancing complications.  

Acceptability

Surgeons are likely to accept that there may be a higher risk of nonunion based on certain fracture characteristics, although this clinical practice guideline is not making treatment recommendations.

Feasibility

 Guidelines regarding risk provide surgeons with information to help counsel patients and guide treatment but no treatment recommendations are provided here.

Future Research

Further research regarding outcomes is needed so that surgeons can make treatment decisions based on the risk of nonunion.