title: Introducing the Surgical Therapeutic Index in trauma surgery: an assessment tool for the benefits and risks of operative fracture treatment strategies.
abstract: BACKGROUND
  The Surgical Therapeutic Index (STI) has been described as an indicator of the benefits and risks of surgical treatment. The index is calculated by dividing the cure rate of an operative treatment by the complication rate. This study introduces the STI in trauma surgery by comparing the indices for surgical plate fixation (PF) and intramedullary fixation (IMF) of displaced midshaft clavicular fractures.
  
  
  METHODS
  In a previously reported, randomized controlled fashion, 120 patients were assigned to PF or IMF. Cure was defined by a Disabilities of the Arm, Shoulder and Hand score of 8 or less. Complications were noted as present or not present for each follow-up assessment, and a panel of experts provided weights to the severity of complications. STIs were reported along with their 95% confidence intervals. The higher a procedure's STI, the higher the benefit/risk balance of that procedure.
  
  
  RESULTS
  The nonweighted STI after 6 weeks was significantly higher in the PF group. During further follow- up, the differences leveled out and became nonsignificant. When weighting the STI for severity, the indices decrease but are significantly in favor of the PF group at 6 weeks and 6 months after surgery. At 1 year postoperatively, differences are not significant.
  
  
  CONCLUSIONS
  The STI may be a reliable tool to assess the benefits and risks of operative fracture treatment. Further studies with consistent results of this new scoring system are needed before conclusions can be generalized. When determining the indices of PF and IMF, a significant difference in favor of PF was observed during the early phase of recovery.
authors: Department of Orthpaedic Surgery, SpaarneGasthuis, Hoofddorp, The Netherlands.
authors: Olivier A
authors: OA
authors: van der Meijden
authors: Utrecht Traumacenter, Utrecht, The Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: R Marijn
authors: RM
authors: Houwert
authors: Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors: Frans-Jasper G
authors: FG
authors: Wijdicks
authors: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors: Marcel G W
authors: MG
authors: Dijkgraaf
authors: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors: Loek P H
authors: LP
authors: Leenen
authors: Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Michiel H J
authors: MH
authors: Verhofstad
authors: Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands. Electronic address: ejverleisdonk@gmail.com.
authors: Egbert J M M
authors: EJ
authors: Verleisdonk
mesh_terms: D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D000066491:Clinical Decision-Making; D000070628:Closed Fracture Reduction; D005260:Female; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D015203:Reproducibility of Results; D018570:Risk Assessment
keywords: Clavicle fractures; displaced; intramedullary fixation; operative treatment; plate fixation; surgical therapeutic index