Clavicle fixation to reduce short-term analgesia and improve respiratory function in patients with chest wall injuries

Abstract

Abstract Introduction The objective of this study was to determine if operative fixation of clavicle fractures in patients with non-operatively treated ipsilateral rib fractures is associated with a lower overall analgesic requirement and improved respiratory function. Materials and methods A retrospective matched cohort study was conducted involving patients admitted to a single tertiary trauma centre having sustained a clavicle fracture with ipsilateral rib fracture/s between January 2014 and June 2020. Patients were excluded if brain, abdominal, pelvic, or lower limb trauma was identified. 31 patients with operative clavicle fixation (study group) were matched 1:1 to 31 patients with non-operative management of the clavicle fracture (control group) based on age, sex, number of rib fractures and injury severity score. The primary outcome was the number of analgesic types used, and the secondary outcome was respiratory function. Results The study group required a mean of 3.50 types of analgesia prior to surgery which decreased to 1.57 post-surgery. The control group required 2.92 types of analgesia, reducing to 1.65 after the date of surgery in the study group. A General Linear Mixed Model indicated that the intervention (operative vs. non-operative management) had statistically significant effects on the number of required analgesic types (p < 0.001, $$\eta_{{\text{p}}}^{2}$$ η p 2  = 0.365), oxygen saturation (p = 0.001, $$\eta_{{\text{p}}}^{2}$$ η p 2  = 0.341, 95% CI 0.153–0.529) and temporal decline in daily supplemental oxygen requirement (p < 0.001, $$\eta_{{\text{p}}}^{2}$$ η p 2  = 0.626, 95% CI 0.455–0.756). Conclusion This study supported the hypothesis that operative clavicle fixation reduces short-term in-patient analgesia use and improves respiratory parameters in patients with ipsilateral rib fractures. Level of evidence Level III therapeutic study.