OBJECTIVES: To assess the rates of surgical treatment, infection, non-union, mal-union along with reoperations and costs in patients with clavicle fractures.

METHODS: This retrospective observational cohort study used Truven MarketScan® Commercial claims database. Patients with diagnosis of clavicle fracture (index) between 2012 and 2016 were identified. Patient demographics and comorbidities at time of fracture were evaluated using the Charlson Comorbidity Index (CCI). Surgical treatment was defined as a procedure within four weeks after clavicle fracture that included an internal fixation device like plate, screw, tightrope or unspecified. Among patients treated surgically for clavicle fractures the rates of complications (infection, non-union, mal-union and reoperations) were reported at one year post-index. Reoperations were defined as device removal or repeat clavicle surgical treatment. Additionally, all-cause health care costs were reported during one year post-clavicle fracture for patients with surgical treatment. All costs were adjusted for inflation using 2016 consumer price index.

RESULTS: A total of 95,243 patients with clavicle fracture were identified. The mean (SD) age was 23.8(18.6) years and 70.9% were males with infrequent comorbidities, 86.4% patients had a CCI=0. 15.2% patients received surgical treatment for clavicle fractures. The rates of infection, non-union and mal-union were 1.0%, 3.9% and 0.9% respectively, at 1 year post-index. Reoperations occurred in 84.4% of patients. Among patients with surgical treatment the mean (SD) all-cause costs during the one year follow-up from index clavicle fractures were $20,567 ($30,192) that comprised of the medical costs of $19,501 ($29,251) and pharmacy costs of $1,065 ($4,682).

CONCLUSIONS: Although patients treated with surgical treatment for clavicle fractures had low rates of infection, non-union and mal-union, these patients had very high rates of subsequent device removal or repeat clavicle surgical treatment. Improved surgical procedures including internal fixation device could reduce the rate of non-planned reoperation and reduce the costs to healthcare system.