PMID- 37328099
OWN - NLM
STAT- Publisher
LR  - 20230908
IS  - 1877-0568 (Electronic)
IS  - 1877-0568 (Linking)
DP  - 2023 Jun 14
TI  - Factors affecting duration of inability to work after intramedullary 
      stabilization of displaced midshaft clavicular fractures.
PG  - 103643
LID - S1877-0568(23)00134-2 [pii]
LID - 10.1016/j.otsr.2023.103643 [doi]
AB  - BACKGROUND: Duration of inability to work (DIW) after displaced midshaft 
      clavicular fractures (DMCF) is an important clinical and socioeconomic treatment 
      outcome. However, evidence on DIW after DMCF intramedullary stabilization (IMS) 
      is still limited. We aimed to examine DIW and identify medical and socioeconomic 
      predictors with direct or indirect impact on DIW after IMS of DMCF. HYPOTHESIS: 
      Socioeconomic predictors can explain the unique proportion of the DIW variance 
      after IMS of DMCF above the variance explained by medical predictors. PATIENTS 
      AND METHODS: Using a retrospective cohort unicentric design, we included patients 
      surgically treated with IMS after DMCF from 2009-2022 with employment status 
      subject to compulsory social security contributions, and without major 
      postoperative complications, in one level II trauma center in Germany. In total, 
      we tested the impact of 17 different medical (i.e., smoking, body mass index 
      [BMI], operative duration, etc.) and socioeconomic predictors (i.e., health 
      insurance type, physical workload, etc.) on DIW. Statistics included multiple 
      regression and path analyses. RESULTS: A total of 166 patients met the 
      eligibility criteria, with DIW 35.1+/-31.1days. Operative duration, physical 
      workload, and physical therapy prolonged the DIW (p<0.001). In contrast, 
      enrollment in private health insurance reduced the DIW (p<0.05). Furthermore, the 
      effect of BMI and fracture complexity on DIW was fully mediated by operative 
      duration. The model explained 43% of the DIW variance. DISCUSSION: Socioeconomic 
      factors were found to directly predict the DIW, even after controlling for 
      medical predictors, which confirmed our research question. This is in line with 
      previous findings and highlights the relevance of socioeconomic predictors in 
      this context. We believe that the proposed model can serve surgeons and patients 
      as an orientation guide to estimate the DIW after IMS of DMCF. LEVEL OF EVIDENCE: 
      IV - retrospective observational cohort study with no control group.
CI  - Copyright (c) 2023 Elsevier Masson SAS. All rights reserved.
FAU - Langenhan, Ronny
AU  - Langenhan R
AD  - Department of Orthopedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 
      10, 78224 Singen, Germany; Department of Orthopedic Surgery, Klinikum Chemnitz 
      gGmbH, Flemmingstrasse 2, 09116 Chemnitz, Germany. Electronic address: 
      ronnyla@gmx.de.
FAU - Trifunovic-Koenig, Milena
AU  - Trifunovic-Koenig M
AD  - Training Center for Emergency Medicine (NOTIS e.V), 7, Breitestrasse, 78234 
      Engen, Germany; Institute for Infection Control and Infection Prevention, 
      Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78415 
      Konstanz, Germany.
FAU - Probst, Axel
AU  - Probst A
AD  - Department of Orthopedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 
      10, 78224 Singen, Germany.
FAU - Kilper, Anica
AU  - Kilper A
AD  - Department of Orthopedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 
      09116 Chemnitz, Germany.
FAU - Bushuven, Stefan
AU  - Bushuven S
AD  - Training Center for Emergency Medicine (NOTIS e.V), 7, Breitestrasse, 78234 
      Engen, Germany; Institute for Infection Control and Infection Prevention, 
      Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78415 
      Konstanz, Germany; Department of Anesthesiology and Critical Care, Faculty of 
      Medicine, Medical Center-University of Freiburg, 79110 Freiburg, Germany.
FAU - Schutz, Ludwig
AU  - Schutz L
AD  - Department of Orthopedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 
      09116 Chemnitz, Germany.
FAU - Reimers, Niklas
AU  - Reimers N
AD  - Department of Orthopedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 
      09116 Chemnitz, Germany.
LA  - eng
PT  - Journal Article
DEP - 20230614
PL  - France
TA  - Orthop Traumatol Surg Res
JT  - Orthopaedics & traumatology, surgery & research : OTSR
JID - 101494830
SB  - IM
OTO - NOTNLM
OT  - Clavicle
OT  - Duration of inability to work
OT  - Fracture
OT  - Intramedullary stabilization
OT  - REFA
OT  - Return to work
EDAT- 2023/06/17 05:11
MHDA- 2023/06/17 05:11
CRDT- 2023/06/16 19:18
PHST- 2022/11/28 00:00 [received]
PHST- 2023/03/22 00:00 [revised]
PHST- 2023/05/19 00:00 [accepted]
PHST- 2023/06/17 05:11 [pubmed]
PHST- 2023/06/17 05:11 [medline]
PHST- 2023/06/16 19:18 [entrez]
AID - S1877-0568(23)00134-2 [pii]
AID - 10.1016/j.otsr.2023.103643 [doi]
PST - aheadofprint
SO  - Orthop Traumatol Surg Res. 2023 Jun 14:103643. doi: 10.1016/j.otsr.2023.103643.