Factors affecting duration of inability to work after intramedullary stabilization of displaced midshaft clavicular fractures

Ronny Langenhan; Milena Trifunovic-Koenig; Axel Probst; Anica Kilper; Stefan Bushuven; Ludwig Schütz; Niklas Reimers

doi:10.1016/j.otsr.2023.103643

Factors affecting duration of inability to work after intramedullary stabilization of displaced midshaft clavicular fractures

Orthop Traumatol Surg Res. 2023 Jun 14:103643. doi: 10.1016/j.otsr.2023.103643. Online ahead of print.

Authors

Ronny Langenhan¹, Milena Trifunovic-Koenig², Axel Probst³, Anica Kilper⁴, Stefan Bushuven⁵, Ludwig Schütz⁴, Niklas Reimers⁴

Affiliations

¹ Department of Orthopedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224 Singen, Germany; Department of Orthopedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116 Chemnitz, Germany. Electronic address: ronnyla@gmx.de.
² Training Center for Emergency Medicine (NOTIS e.V), 7, Breitestrasse, 78234 Engen, Germany; Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78415 Konstanz, Germany.
³ Department of Orthopedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224 Singen, Germany.
⁴ Department of Orthopedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116 Chemnitz, Germany.
⁵ Training Center for Emergency Medicine (NOTIS e.V), 7, Breitestrasse, 78234 Engen, Germany; Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78415 Konstanz, Germany; Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center-University of Freiburg, 79110 Freiburg, Germany.

PMID: 37328099
DOI: 10.1016/j.otsr.2023.103643

Abstract

Background: Duration of inability to work (DIW) after displaced midshaft clavicular fractures (DMCF) is an important clinical and socioeconomic treatment outcome. However, evidence on DIW after DMCF intramedullary stabilization (IMS) is still limited. We aimed to examine DIW and identify medical and socioeconomic predictors with direct or indirect impact on DIW after IMS of DMCF.

Hypothesis: Socioeconomic predictors can explain the unique proportion of the DIW variance after IMS of DMCF above the variance explained by medical predictors.

Patients and methods: Using a retrospective cohort unicentric design, we included patients surgically treated with IMS after DMCF from 2009-2022 with employment status subject to compulsory social security contributions, and without major postoperative complications, in one level II trauma center in Germany. In total, we tested the impact of 17 different medical (i.e., smoking, body mass index [BMI], operative duration, etc.) and socioeconomic predictors (i.e., health insurance type, physical workload, etc.) on DIW. Statistics included multiple regression and path analyses.

Results: A total of 166 patients met the eligibility criteria, with DIW 35.1±31.1days. Operative duration, physical workload, and physical therapy prolonged the DIW (p<0.001). In contrast, enrollment in private health insurance reduced the DIW (p<0.05). Furthermore, the effect of BMI and fracture complexity on DIW was fully mediated by operative duration. The model explained 43% of the DIW variance.

Discussion: Socioeconomic factors were found to directly predict the DIW, even after controlling for medical predictors, which confirmed our research question. This is in line with previous findings and highlights the relevance of socioeconomic predictors in this context. We believe that the proposed model can serve surgeons and patients as an orientation guide to estimate the DIW after IMS of DMCF.

Level of evidence: IV - retrospective observational cohort study with no control group.

Keywords: Clavicle; Duration of inability to work; Fracture; Intramedullary stabilization; REFA; Return to work.