Top

Current Reviews in Musculoskeletal Medicine

Published in:

Open Access 01-08-2020 | Clavicle Fracture | Hot Topics

Cost-Effectiveness of Operative Versus Non-Operative Treatment for Clavicle Fracture: a Systematic Literature Review

Authors: Gilber Kask, Lauri Raittio, Ville M. Mattila, Antti P. Launonen

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2020

Abstract

Purpose of Review

Operative and non-operative treatment of midshaft clavicle fractures seems to yield comparative functional results. Furthermore, it has been suggested that surgery is more expensive compared with non-operative treatment of clavicle fracture. Cost-effectiveness seems to be more important in trends of treatment decisions. The purpose of this study is to investigate the cost-effectiveness of clavicle fracture treatment.

Recent Findings

Seven publications were selected, and 5 studies showed that operative treatment is more expensive than non-operative treatment. The mean overall cost per person in discounted prices was 10,230 USD for operative and 7923 USD for non-operative treatment. The mean absence from work ranged 8–193 and 24–69 days for operative and non-operative treatment, respectively. Studies varied in methods of assessing the cost-effectiveness of treatment modalities.

Summary

Based on this literature review, routine operative treatment seems to be more expensive. In some cases, operative treatment might be more cost-effective. In all studies, direct and indirect costs of health care were calculated, but a great heterogeneity exists in the sources of cost data between countries. The cost-effectiveness of the treatment of clavicle fracture depends strongly on the cost of operative treatment and length of absence from work. Cost-effectiveness analysis could be a routine in RCT studies in the future.

Available only for authorised users

Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.CrossRef

Ballmer FT, Lambert SM, Hertel R. Decortication and plate osteosynthesis for nonunion of the clavicle. J Shoulder Elb Surg. 1998;7(6):581–5.CrossRef

Boyer MI, Axelrod TS. Atrophic nonunion of the clavicle: treatment by compression plate, lag-screw fixation and bone graft. J Bone Joint Surg (Br). 1997;79(2):301–3.CrossRef

Coupe BD, Wimhurst JA, Indar R, Calder DA, Patel AD. A new approach for plate fixation of midshaft clavicular fractures. Injury. 2005;36(10):1166–71. https://doi.org/10.1016/j.injury.2005.03.007.CrossRefPubMed

Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91(2):447–60. https://doi.org/10.2106/JBJS.H.00034.CrossRefPubMed

Marti RK, Nolte PA, Kerkhoffs GM, Besselaar PP, Schaap GR. Operative treatment of mid-shaft clavicular non-union. Int Orthop. 2003;27(3):131–5. https://doi.org/10.1007/s00264-002-0424-7.CrossRefPubMedPubMedCentral

Pai HT, Lee YS, Cheng CY. Surgical treatment of midclavicular fractures in the elderly: a comparison of locking and nonlocking plates. Orthopedics. 2009;32(4).

Virtanen KJ, Malmivaara AO, Remes VM, Paavola MP. Operative and nonoperative treatment of clavicle fractures in adults. Acta Orthop. 2012;83(1):65–73. https://doi.org/10.3109/17453674.2011.652884.CrossRefPubMedPubMedCentral

Woltz S, Krijnen P, Schipper IB. Plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2017;99(12):1051–7. https://doi.org/10.2106/JBJS.16.01068.CrossRefPubMed

10.

Rehn CH, Kirkegaard M, Viberg B, Larsen MS. Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults: a systematic review. Eur J Orthop Surg Traumatol. 2014;24(7):1047–53. https://doi.org/10.1007/s00590-013-1370-3.CrossRefPubMed

11.

Huttunen TT, Kannus P, Lepola V, Pihlajamaki H, Mattila VM. Surgical treatment of clavicular fractures in Finland-a register based study between 1987 and 2010. Injury. 2013;44(12):1899–903. https://doi.org/10.1016/j.injury.2013.09.006.CrossRefPubMed

12.

• Ahrens PM, Garlick NI, Barber J, Tims EM, Clavicle Trial Collaborative G. The Clavicle trial: a multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures. J Bone Joint Surg Am. 2017;99(16):1345–54. https://doi.org/10.2106/JBJS.16.01112Multicentre randomized controlled trial reporting that postoperative functional outcome was significantly better in the operative group than in the nonoperative group at 6 weeks and 3 months, but not at 9 months. CrossRefPubMed

13.

Canadian Orthopaedic Trauma S. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1–10. https://doi.org/10.2106/JBJS.F.00020.CrossRef

14.

Melean PA, Zuniga A, Marsalli M, Fritis NA, Cook ER, Zilleruelo M, et al. Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population. J Shoulder Elb Surg. 2015;24(4):587–92. https://doi.org/10.1016/j.jse.2014.11.041.CrossRef

15.

Mirzatolooei F. Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Acta Orthop Traumatol Turc. 2011;45(1):34–40. https://doi.org/10.3944/AOTT.2011.2431.CrossRefPubMed

16.

Bhardwaj A, Sharma G, Patil A, Rahate V. Comparison of plate osteosynthesis versus non-operative management for mid-shaft clavicle fractures-a prospective study. Injury. 2018;49(6):1104–7. https://doi.org/10.1016/j.injury.2018.04.012.CrossRefPubMed

17.

• Qvist AH, Vaesel MT, Jensen CM, Jensen SL. Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures: a randomized clinical trial. Bone Joint J. 2018;100-B(10):1385–91. https://doi.org/10.1302/0301-620X.100B10.BJJ-2017-1137.R3Multicentre randomized controlled trial reporting that operative treatment of displaced midshaft clavicular fractures results in faster functional recovery compared with nonoperative management, but the function is equal after 6 months. CrossRefPubMed

18.

Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95(17):1576–84. https://doi.org/10.2106/JBJS.L.00307.CrossRefPubMed

19.

Clement ND, Goudie EB, Brooksbank AJ, Chesser TJ, Robinson CM. Smoking status and the Disabilities of the Arm Shoulder and Hand score are early predictors of symptomatic nonunion of displaced midshaft fractures of the clavicle. Bone Joint J. 2016;98-B(1):125–30. https://doi.org/10.1302/0301-620X.98B1.36260.CrossRefPubMed

20.

Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am. 2013;95(13):1153–8. https://doi.org/10.2106/JBJS.K.01275.CrossRefPubMed

21.

Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997;43(5):778–83.CrossRef

22.

Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006–11.CrossRef

23.

Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504–7.CrossRef

24.

Reito A, Launonen AP, Paloneva J. Factors explaining heterogeneity in studies comparing surgical and nonsurgical treatment of midshaft clavicle fractures: a meta-regression analysis of randomized controlled trials and high quality observational studies. Accepted for publication; Journar of Shoulder and elbow surgery.

25.

Brauer CA, Rosen AB, Olchanski NV, Neumann PJ. Cost-utility analyses in orthopaedic surgery. J Bone Joint Surg Am. 2005;87(6):1253–9. https://doi.org/10.2106/JBJS.D.02152.CrossRefPubMed

26.

Pearson AM, Tosteson AN, Koval KJ, McKee MD, Cantu RV, Bell JE, et al. Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter randomized, controlled trial. J Orthop Trauma. 2010;24(7):426–33. https://doi.org/10.1097/BOT.0b013e3181c3e505.CrossRefPubMed

27.

• Smeeing DPJ, van der Ven DJC, Hietbrink F, Timmers TK, van Heijl M, Kruyt MC, et al. Surgical versus nonsurgical treatment for midshaft clavicle fractures in patients aged 16 years and older: a systematic review, meta-analysis, and comparison of randomized controlled trials and observational studies. Am J Sports Med. 2017;45(8):1937–45. https://doi.org/10.1177/0363546516673615This meta-analysis showed that surgical treatment of midshaft clavicle fractures results in an accelerated return to work compared with nonsurgical treatment.CrossRefPubMed

28.

•• Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I. Patient factors influencing return to work and cumulative financial claims after clavicle fractures in workers’ compensation cases. J Shoulder Elb Surg. 2016;25(7):1115–21. https://doi.org/10.1016/j.jse.2016.02.004This study represents the most valid method for gathering data on absence from work, in cases were all injuries and patients are added to the database. CrossRef

29.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700.CrossRefPubMedPubMedCentral

30.

Chiou CF, Hay JW, Wallace JF, Bloom BS, Neumann PJ, Sullivan SD, et al. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. 2003;41(1):32–44. https://doi.org/10.1097/01.MLR.0000039824.73620.E5.CrossRefPubMed

31.

Peterson LE, Goodman C, Karnes EK, Chen CJ, Schwartz JA. Assessment of the quality of cost analysis literature in physical therapy. Phys Ther. 2009;89(8):733–55. https://doi.org/10.2522/ptj.20080326.CrossRefPubMed

32.

Smart KA, Lanctot KL, Paes BA. The cost effectiveness of palivizumab: a systematic review of the evidence. J Med Econ. 2010;13(3):453–63. https://doi.org/10.3111/13696998.2010.499749.CrossRefPubMed

33.

Hussman JM, Lanctot KL, Paes B. The cost effectiveness of palivizumab in congenital heart disease: a review of the current evidence. J Med Econ. 2013;16(1):115–24. https://doi.org/10.3111/13696998.2012.734886.CrossRefPubMed

34.

Nwachukwu BU, Schairer WW, O'Dea E, McCormick F, Lane JM. The quality of cost-utility analyses in orthopedic trauma. Orthopedics. 2015;38(8):e673–80. https://doi.org/10.3928/01477447-20150804-53.CrossRefPubMed

35.

• Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093-1103. ddoi:https://doi.org/10.1001/jama.2016.12195. Important due to the general knowledge in cost-effectiveness research for need to adjust price information due to inflation.

36.

Althausen PL, Shannon S, Lu M, O'Mara TJ, Bray TJ. Clinical and financial comparison of operative and nonoperative treatment of displaced clavicle fractures. J Shoulder Elb Surg. 2013;22(5):608–11. https://doi.org/10.1016/j.jse.2012.06.006.CrossRef

37.

• Liu J, Srivastava K, Washington T, Hoegler J, Guthrie ST, Hakeos W, et al. Cost-effectiveness of operative versus nonoperative treatment of displaced midshaft clavicle fractures: a decision analysis. J Bone Joint Surg Am. 2019;101(1):35–47. https://doi.org/10.2106/JBJS.17.00786Maximum score of The Quality of Health Economic Studies (QHES) instrument, which was used in the assessment of the quality of the included studies. CrossRefPubMed

38.

Nicholson JA, Clement N, Goudie EB, Robinson CM. Routine fixation of displaced midshaft clavicle fractures is not cost-effective: a cost analysis from a randomized controlled trial. Bone Joint J. 2019;101-B(8):995–1001. https://doi.org/10.1302/0301-620X.101B8.BJJ-2018-1253.R2.CrossRefPubMed

39.

• Sorensen AR, Hammeken LH, Qvist AH, Jensen SL, Ehlers LH. Operative treatment of displaced midshaft clavicular fractures is not cost-effective. J Shoulder Elb Surg. 2020;29(1):27–35. https://doi.org/10.1016/j.jse.2019.07.020Study highlights that for patients with a high-load shoulder profession, operative treatment might be cost-effective compared with nonoperative treatment.CrossRef

40.

Herteleer M, De Jaegere A, Winckelmans T, Casteur H, Nijs S, Hoekstra H. Healthcare utilization and related cost of midshaft clavicle fracture treatment in Belgium. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01307-2.

41.

Walton B, Meijer K, Melancon K, Hartman M. A cost analysis of internal fixation versus nonoperative treatment in adult midshaft clavicle fractures using multiple randomized controlled trials. J Orthop Trauma. 2015;29(4):173–80. https://doi.org/10.1097/BOT.0000000000000225.CrossRefPubMed

42.

Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. 2009;23(2):106–12. https://doi.org/10.1097/BOT.0b013e318190cf88.CrossRefPubMed

43.

Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ). 2009;38(7):341–5.

44.

McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94(8):675–84. https://doi.org/10.2106/JBJS.J.01364.CrossRefPubMed

45.

van der Ven Denise JC, Timmers TK, Flikweert PE, Van Ijseldijk AL, van Olden GD. Plate fixation versus conservative treatment of displaced midshaft clavicle fractures: functional outcome and patients’ satisfaction during a mean follow-up of 5 years. Injury. 2015;46(11):2223–9. https://doi.org/10.1016/j.injury.2015.08.004.CrossRefPubMed

46.

•• King MT. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11(2):171–84. https://doi.org/10.1586/erp.11.9.Important for readership as the mainstay in effectiveness research investigates the relative performance of treatments in PROMs and compare the results to minimal clinical important difference values for the particular PROM.CrossRefPubMed

47.

•• Hao Q, Devji T, Zeraatkar D, Wang Y, Qasim A, Siemieniuk RAC, et al. Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform a BMJ Rapid Recommendation. BMJ Open. 2019;9(2):e028777. https://doi.org/10.1136/bmjopen-2018-028777This review reports anchor-based minimal important difference estimates for PROMs in patients with shoulder conditions.CrossRefPubMedPubMedCentral

48.

Kim SJ, Lee BG, Lee CH, Choi WS, Kim JH, Lee KH. Comparison of ceiling effects between two patient-rating scores and a physician-rating score in the assessment of outcome after the surgical treatment of distal radial fractures. Bone Joint J. 2015;97-B(12):1651–6. https://doi.org/10.1302/0301-620X.97B12.35723.CrossRefPubMed

49.

Fries J, Rose M, Krishnan E. The PROMIS of better outcome assessment: responsiveness, floor and ceiling effects, and internet administration. J Rheumatol. 2011;38(8):1759–64. https://doi.org/10.3899/jrheum.110402.CrossRefPubMed

50.

Jayakumar P, Teunis T, Vranceanu AM, Lamb S, Williams M, Ring D, et al. Construct validity and precision of different patient-reported outcome measures during recovery after upper extremity fractures. Clin Orthop Relat Res. 2019;477(11):2521–30. https://doi.org/10.1097/CORR.0000000000000928.CrossRefPubMed

51.

MacDermid JC, Roth JH, McMurtry R. Predictors of time lost from work following a distal radius fracture. J Occup Rehabil. 2007;17(1):47–62. https://doi.org/10.1007/s10926-007-9069-0.CrossRefPubMed

52.

Wong JY. Time off work in hand injury patients. J Hand Surg [Am]. 2008;33(5):718–25. https://doi.org/10.1016/j.jhsa.2008.01.015.CrossRef

53.

Guide to the Methods of Technology Appraisal 2013. NICE process and methods guides. London2013.

54.

Shearer J, Byford S, Birch S. Reflections on the Nice decision to reject patient production losses. Int J Technol Assess Health Care. 2017;33(6):638–43. https://doi.org/10.1017/S0266462317000952.CrossRefPubMed

55.

•• van Lier LI, Bosmans JE, van Hout HPJ, Mokkink LB, van den Hout WB, de Wit GA, et al. Consensus-based cross-European recommendations for the identification, measurement and valuation of costs in health economic evaluations: a European Delphi study. Eur J Health Econ. 2017. https://doi.org/10.1007/s10198-017-0947-xImportant for readers to have a reference for viewpoints from health economic experts on the debate of including or not including the costs of absence from work in cost-effectiveness studies.

Title: Cost-Effectiveness of Operative Versus Non-Operative Treatment for Clavicle Fracture: a Systematic Literature Review
Authors: Gilber Kask
Lauri Raittio
Ville M. Mattila
Antti P. Launonen
Publication date: 01-08-2020
Publisher: Springer US
Keyword: Clavicle Fracture
Published in: Current Reviews in Musculoskeletal Medicine / Issue 4/2020
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09640-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cost-Effectiveness of Operative Versus Non-Operative Treatment for Clavicle Fracture: a Systematic Literature Review

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 4/2020

The Role of Biologic Agents in the Non-operative Management of Elbow Ulnar Collateral Ligament Injuries

Evaluation and Management of Preaxial Polydactyly

A Comprehensive Review of Radiohumeral Synovial Plicae for a Correct Clinical Interpretation in Intractable Lateral Epicondylitis

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

Ethical and Practical Considerations for Integrating Cellular (“Stem Cell”) Therapy into Clinical Practice

Cannabinoid Use in Musculoskeletal Illness: a Review of the Current Evidence