title: Frequency and complications after operative fixation of clavicular fractures.
abstract: BACKGROUND
  The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicular fractures is matched with an increase in operative fixation and complication rates in the United States.
  
  
  METHODS
  The American Board of Orthopaedic Surgery database was reviewed for cases with Current Procedural Terminology (American Medical Association, Chicago, IL, USA) code 23515 (clavicle open reduction internal fixation [ORIF]) from 1999 to 2010. The procedure rate for each year and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if a change had occurred in the frequency of ORIF for clavicular fractures. Complication and outcome data were also reviewed.
  
  
  RESULTS
  In 2010 vs, 1999, there were statistically significant increases in the mean number of clavicle ORIF performed among all candidates (0.89 vs. 0.13; P < .0001) and in the mean number of clavicle ORIF per candidate performing clavicle ORIF (2.47 vs. 1.20, P < .0473). The difference in the percentage of part II candidates performing clavicle ORIF from the start to the end of the study (11% vs. 36%) was significant (P < .0001). There was a significant increase in the clavicle ORIF percentage of total cases (0.11% vs. 0.74%, P < .0001). The most common complication was hardware failure (4%).
  
  
  CONCLUSIONS
  The rate of ORIF of clavicular fractures has increased in candidates taking part II of the American Board of Orthopaedic Surgery, with a low complication rate. The increase in operative fixation during this interval may have been influenced by literature suggesting improved outcomes in patients treated with operative stabilization of their clavicular fracture.
authors.affiliation: Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center, Torrance, CA, USA. Electronic address: ivan.a.garcia@kp.org.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Navarro
authors.affiliation: Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Gelber
authors.affiliation: American Board of Orthopaedic Surgery, Hinsdale, IL, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Harrast
authors.affiliation: Georgia Hand, Shoulder, and Elbow, Atlanta, GA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Seiler
authors.affiliation: Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center, Torrance, CA, USA.
authors.forename: Kent R
authors.initials: KR
authors.lastname: Jackson
authors.affiliation: Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA.
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Garcia
mesh_terms: D000328:Adult; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000639:trends*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D008297:Male; D000070799:Open Fracture Reduction / Q000009:adverse effects / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011475:Prosthesis Failure; D014481:United States / Q000453:epidemiology
keywords: ABOS; Clavicle; Complications; Fixation; Fracture; Rate; Shoulder