TREATMENT OF CLAVICLE FRACTURES - American Academy of ...

TREATMENT OF CLAVICLE FRACTURES

Evidence-Based Clinical Practice Guideline

Adapted by: The American Academy of Orthopaedic Surgeons Board of Directors December 2, 2022

Endorsed by:

Please cite this guideline as: American Academy of Orthopaedic Surgeons Treatment of Clavicle Fractures Evidence-Based Clinical

Practice Guideline. aaos/org/claviclecpg Published 12/02/2022

View background materials via the CPG eAppendix 1 View data summaries via the CPG eAppendix 2

Disclaimer

This clinical practice guideline (CPG) was developed by a physician volunteer clinical practice guideline development group based on a formal systematic review of the available scientific and clinical information and accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician's independent medical judgment, given the individual patient's specific clinical circumstances.

Disclosure Requirement In accordance with AAOS policy, all individuals whose names appear as authors or contributors to the clinical practice guideline filed a disclosure statement as part of the submission process. All panel members provided full disclosure of potential conflicts of interest prior to voting on the recommendations contained within this clinical practice guideline.

Funding Source This clinical practice guideline was funded exclusively by the American Academy of Orthopaedic Surgeons who received no funding from outside commercial sources to support the development of this document.

FDA Clearance Some drugs or medical devices referenced or described in this clinical practice guideline may not have been cleared by the Food and Drug Administration (FDA) or may have been cleared for a specific use only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice.

Copyright All rights reserved. No part of this clinical practice guideline may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the AAOS. If you wish to request permission, please contact the AAOS Department of Clinical Quality and Value at orthoguidelines@.

Published xxxx by the American Academy of Orthopaedic Surgeons 9400 Higgins Road Rosemont, IL 60018 First Edition Copyright 2022 by the American Academy of Orthopaedic Surgeons

2 View background material via the CPG eAppendix 1 View data summaries via the CPG eAppendix 2

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CONTENTS

CONTENTS..................................................................................................................................................................... 4 SUMMARY OF RECOMMENDATIONS ...........................................................................................................................6

BONE STIMULATOR..................................................................................................................................................6 HOOK PLATE vs. LATERAL LOCKING PLATE FOR LATERAL FRACTURE ....................................................................6 ISOLATED DISPLACED MIDSHAFT FRACTURE: OPERATIVE vs. NONOPERATIVE TREATMENT (ADULT) ................7 NAILING vs. SINGLE PLATE .......................................................................................................................................7 SUMMARY OF OPTIONS................................................................................................................................................8 NON-MODIFIABLE RISK FACTORS: AGE AND SEX....................................................................................................8 MODIFIABLE RISK FACTORS: SMOKING...................................................................................................................8 DUAL PLATING..........................................................................................................................................................8 ANTERIOR vs. SUPERIOR PLATING...........................................................................................................................9 PRE-CONTOURED PLATE vs. NON-PRE-CONTOURED PLATE...................................................................................9 RADIOGRAPH: SUPINE vs. UPRIGHT........................................................................................................................9 PREDICTORS OF NON-UNION FOLLOWING NONOPERATIVELY TREATED CLAVICLE FRACTURES .......................10 ISOLATED DISPLACED MIDSHAFT FRACTURE: OPERATIVE vs. NONOPERATIVE (ADOLESCENT 18 YEARS OLD) ................................................................................................................................................................................ 10 IMMOBILIZATION METHOD...................................................................................................................................10 LATERAL CLAVICLE FRACTURE: OPERATIVE vs. NONOPERATIVE TREATMENT ....................................................11 DEVELOPMENT GROUP ROSTER .................................................................................................................................12 VOTING MEMBERS.................................................................................................................................................12 CONTRIBUTORS ...................................................................................................................................................... 12 AAOS STAFF ............................................................................................................................................................13 INTRODUCTION ........................................................................................................................................................... 14 OVERVIEW ..............................................................................................................................................................14 GOALS AND RATIONALE.........................................................................................................................................14 INTENDED USERS....................................................................................................................................................14 PATIENT POPULATION ...........................................................................................................................................15 SCOPE...................................................................................................................................................................... 15 ETIOLOGY ................................................................................................................................................................ 15 INCIDENCE AND PREVALENCE................................................................................................................................15 BURDEN OF DISEASE ..............................................................................................................................................15 EMOTIONAL AND PHYSICAL IMPACT ....................................................................................................................15 POTENTIAL BENEFITS, HARM, AND CONTRAINDICATIONS ..................................................................................16

4 View background material via the CPG eAppendix 1 View data summaries via the CPG eAppendix 2

METHODS....................................................................................................................................................................16 LITERATURE SEARCHES ..........................................................................................................................................17 DEFINING THE QUALITY OF EVIDENCE ..................................................................................................................17 DEFINING THE STRENGTH OF RECOMMENDATION ..............................................................................................17 VOTING ON THE RECOMMENDATIONS.................................................................................................................18 UNDERSTANDING THE QUALITY OF EVIDENCE AND STRENGTH OF STATEMENT................................................19 Table I. Level of Evidence Descriptions ....................................................................................................19 Table II. Interpreting the Strength of a Recommendation or Option ......................................................... 19 REVIEW PERIOD......................................................................................................................................................20 THE AAOS CPG APPROVAL PROCESS .....................................................................................................................20 REVISION PLANS.....................................................................................................................................................21 CPG DISSEMINATION PLANS..................................................................................................................................21 Study Attrition Flowchart ......................................................................................................................................22

RECOMMENDATIONS .................................................................................................................................................23 BONE STIMULATOR.................................................................................................................................23 HOOK PLATE VS. LATERAL LOCKING PLATE FOR LATERAL FRACTURE.........................................................25 ISOLATED DISPLACED MIDSHAFT FRACTURE: OPERATIVE VS. NON-OPERATIVE TREATMENT [ADULT] ....... 26 NAILING vs. SINGLE PLATE.......................................................................................................................28

OPTIONS......................................................................................................................................................................30 NON-MODIFIABLE RISK FACTORS: AGE AND SEX ......................................................................................30 MODIFIABLE RISK FACTORS: SMOKING....................................................................................................32 DUAL PLATING........................................................................................................................................33 ANTERIOR vs. SUPERIOR PLATING ...........................................................................................................35 PRE-CONTOURED PLATE vs. NON-PRE-CONTOURED PLATE.......................................................................36 RADIOGRAPH: SUPINE vs. UPRIGHT.........................................................................................................38 PREDICTORS OF NON-UNION FOLLOWING NON-OPERATIVELY TREATED CLAVICLE FRACTURE .................. 39 ISOLATED DISPLACED MIDSHAFT FRACTURE: OPERATIVE VS. NON-OPERATIVE TREATMENT [ADOLESCENT 18 YEARS OLD]........................................................................................................................................40 IMMOBILIZATION METHOD.....................................................................................................................42 LATERAL CLAVICLE FRACTURE: OPERATIVE vs. NON-OPERATIVE TREATMENT ........................................... 44

APPENDICES ................................................................................................................................................................ 45 Appendix I: References (for Introduction and Included Literature).......................................................................45 VOTING MEMBERS' AND NON-VOTING OVERSIGHT CHAIRS' DISCLOSURES ......................................................51

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