Does Fixation of Clavicle Fractures Improve Clinical Outcomes in Patients with Concomitant Multiple Rib Fractures?

Abstract Background Clavicle fractures are often accompanied by multiple rib fractures. The combination of these injuries results in decreased stability of the chest wall making these patients vulnerable to prolonged hospitalization and (respiratory) complications. Aims This study aims to assess whether performing clavicle fixation would improve clinical outcomes by adding chest wall stability. Methods A prospective multicenter study was performed including all adult patients with both multiple rib fractures and ipsilateral clavicle fractures admitted between January 2018 and March 2021. Patients treated operatively versus nonoperatively for their clavicle fracture were matched using propensity score matching. The primary outcome was the hospital length of stay. The secondary outcomes were, duration of mechanical ventilation, intensive care unit length of stay, pain, complications, and quality of life at 6 weeks and 12 months of follow-up. Results A total of 232 patients with concomitant ipsilateral clavicle and rib fractures were included. Fifty-two patients (22%) underwent operative treatment of which 39 could be adequately matched to 39 nonoperatively treated patients. No association was found between clavicle fixation and the hospital length of stay (mean difference=2.3, 95% CI -2.1 to 6.8, p=0.301) or any secondary endpoint. Eight of the 180 nonoperatively treated patients (4%) had a symptomatic nonunion, for which five underwent secondary clavicle fixation. Conclusions In patients with combined, ipsilateral clavicle and multiple rib fractures, plate fixation of the clavicle does not reduce hospital length of stay, pain, or (pulmonary) complications, nor does it improve quality of life.