Influence of Level 1 Evidence on Management of Clavicle and Distal Humerus Fractures: A Nationwide Comparative Study of Records From 2005 to 2014


The purpose of this study was to examine alterations in national trends managing midshaft clavicle fractures (MCF) and intra-articular distal humerus fractures (DHF) surrounding recent level 1 publications. A retrospective review of the PearlDiver supercomputer for DHF and MCF was performed. Using age limits defined in the original level 1 studies, total use and annual use rates were examined. Nonoperative management and open reduction and internal fixation (ORIF) were reviewed for MCF. ORIF and total elbow arthroplasty (TEA) were reviewed for DHF. A query yielded 4929 MCF and 106,535 DHF patients. A significant increase in ORIF use for MCF following the publication of the level 1 study (p = .002) and a strong, positive correlation (p = .007) were evident. Annual TEA (p = .515) use for DHF was not observed. (Journal of Surgical Orthopaedic Advances 27(3):219–225, 2018)
Key words: clavicle fracture, distal humerus fracture, nonoperative treatment, open reduction and internal fixation, PearlDiver, total elbow arthroplasty

Jennifer Kurowicki, MD; Jacob J. Triplet, DO; Samuel Rosas, MD; Tsun yee Law, MD; Timothy Niedzielak, DO; Enesi Momoh, MD; and Jonathan C. Levy, MD