Increasing incidences and changes in treatment trends of clavicle fractures in adults during 2 decades in Denmark: a nationwide study on data from the Danish National Patient Registry

Authors

  • Ida Tryggedsson Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital; Trauma Orthopaedic Research Copenhagen Hvidovre (TORCH), Department of Orthopaedic Surgery, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark https://orcid.org/0000-0002-0335-4344
  • Bjarke Viberg Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Denmark https://orcid.org/0000-0001-5169-4282
  • Per Hviid Gundtoft Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark
  • Ilija Ban Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, Denmark
  • Søren Overgaard Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0001-6829-4787
  • Tazio Maleitzke Department of Clinical Medicine, University of Copenhagen, Copenhagen; Trauma Orthopaedic Research Copenhagen Hvidovre (TORCH), Department of Orthopaedic Surgery, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Berlin; Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
  • Arvind von Keudell Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital; epartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Harvard Orthopaedic Trauma Initiative, Brigham and Women’s Hospital, Boston, USA

DOI:

https://doi.org/10.2340/17453674.2025.43000

Keywords:

Bone, Fractures, Shoulder

Abstract

Background and purpose: Clavicle fractures are common shoulder injuries, but treatment strategies are debated. While a non-surgical approach has been preferred historically, recent studies suggest surgical intervention may reduce non-union rates and improve outcomes for displaced fractures. Despite ongoing research there is still no consensus on the optimal treatment choice. We aimed to report national incidences and trends in treatment of clavicle fractures in Denmark across 2 decades.
Methods: The Danish National Patient Register was used to extract data on clavicle fracture diagnosis and treatment in patients aged 18 and above from 1996 to 2018. Primary treatment was categorized as surgical if a relevant surgical procedure code was registered within 3 weeks of the fracture code, otherwise treatment was defined as non-surgical.
Results: There were 81,597 clavicle fractures recorded; 67% were in men and the mean age was 50.3 years (standard deviation [SD] 19.5). The overall fracture incidence was 82/100,000/person-years, increasing by 11% from 76 in 1996 to 84 in 2018. The incidence was more than 50% higher in males (113) than females (53). 6,096 cases (7.5%) were treated surgically, mainly with plate osteosynthesis (94%). The surgical rate increased from 1% in 1996 to 14% in 2011, whereafter it decreased again. In 2018, 7% of clavicle fractures were treated surgically, with inter-hospital variations ranging from 0 to 15%.
Conclusion: The incidence of clavicle fractures increased over the period. Non-surgical treatment remained prevalent, though surgical rates fluctuated with plate osteosynthesis being the preferred method.

Downloads

Download data is not yet available.

References

Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification, and treatment of 2,422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskelet Disord 2017; 18(1): 82. doi: 10.1186/s12891-017-1444-1. DOI: https://doi.org/10.1186/s12891-017-1444-1

Hill J M, McGuire M H, Crosby L A. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997; 79(4): 537-9. doi: 10.1302/0301-620X.79B4.7529. DOI: https://doi.org/10.1302/0301-620X.79B4.7529

McKee M, Pedersen E, Jones C, Stephen D, Kreder H, Schemitsch E, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 2006; 88(1): 35-40. doi: 10.2106/JBJS.E.02795. DOI: https://doi.org/10.2106/00004623-200601000-00005

Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multicenter, randomized clinical trial. J Bone Joint Surg Am 2007; 89(1): 1-10. doi: 10.2106/JBJS.F.00020. DOI: https://doi.org/10.2106/JBJS.F.00020

Robinson C M, Goudie E B, Murray I R, Jenkins P J, Ahktar M A, Read E O, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am 2013; 95(17): 1576-84. doi:10.2106/JBJS.L.00307. DOI: https://doi.org/10.2106/JBJS.L.00307

Huttunen T T, Kannus P, Lepola V, Pihlajamäki H, Mattila V M. Surgical treatment of clavicular fractures in Finland: a register-based study between 1987 and 2010. Injury 2013; 44(12): 1899-903. doi: 10.1016/j.injury.2013.09.006. DOI: https://doi.org/10.1016/j.injury.2013.09.006

Huttunen T T, Launonen A P, Berg H E, Lepola V, Fellander-Tsai L, Mattila V M. Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001–2012. J Bone Joint Surg Am 2016; 98(21): 1837-42. doi: 10.2106/JBJS.15.01284. DOI: https://doi.org/10.2106/JBJS.15.01284

Robinson C M. Fractures of the clavicle in the adult: epidemiology and classification. J Bone Joint Surg Br 1998; 80(3): 476-84. doi: 10.1302/0301-620x.80b3.8079. DOI: https://doi.org/10.1302/0301-620X.80B3.8079

Karl J W, Olson P R, Rosenwasser M P. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 2015; 29(4). doi: 10.1097/BOT.0000000000000312. DOI: https://doi.org/10.1097/BOT.0000000000000312

Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures: a prospective study during a 2-year period in Uppsala, Sweden. Injury 2000; 31(5): 353-8. doi: 10.1016/s0020-1383(99)00312-5. DOI: https://doi.org/10.1016/S0020-1383(99)00312-5

Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sørensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-90. doi:10.2147/CLEP.S91125. DOI: https://doi.org/10.2147/CLEP.S91125

Benchimol E I, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015; 12(10). doi:10.1371/journal.pmed.1001885. DOI: https://doi.org/10.1371/journal.pmed.1001885

Schmidt M, Pedersen L, Sørensen H T. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 2014; 29(8): 541-9. doi: 10.1007/s10654-014-9930-3. DOI: https://doi.org/10.1007/s10654-014-9930-3

World Health Organization. International Classification of Diseases, 10th Revision 2019; Available from: https://icd.who.int/browse10/2019/en15.

NOMESCO. Classification of Surgical Procedures 2011; Available from: https://norden.diva-portal.org/smash/get/diva2:968721/FULLTEXT01.pdf

Statistics Denmark 2024; Available from: https://www.dst.dk/en/

Gundtoft P H, Danielsson F B, Houlind M, Mortensen S O, Corap Y, Bonde N, et al. The positive predictive value of ankle fracture diagnosis in the Danish National Patient Registry. Dan Med J 2022; 69(12): A01220032.

Karimi D, Holck L H, Gundtoft P, Brorson S, Viberg B. Positive predictive value of humeral fractures in the Danish National Patient Registry. Dan Med J 2023; 70(4): A10220612.

Ludvigsson J F, Andersson E, Ekbom A, Feychting M, Kim J L, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011; 11(1): 450. doi:10.1186/1471-2458-11-450. DOI: https://doi.org/10.1186/1471-2458-11-450

Virtanen K J, Remes V, Pajarinen J, Savolainen V, Björkenheim J M, Paavola M. Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial. J Bone Joint Surg Am 2012; 94(17): 1546-53. doi: 10.2106/JBJS.J.01999. PMID: 22832887. DOI: https://doi.org/10.2106/JBJS.J.01999

Qvist A H, Vaeggemose A H, Torholm M T, Jensen C M, Jensen S L. Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures: a randomized clinical trial. Bone Joint J 2018; 100-B(10): 1385-91. doi: 10.1302/0301-620X.100B10.BJJ-2017-1137.R3. DOI: https://doi.org/10.1302/0301-620X.100B10.BJJ-2017-1137.R3

Axelrod D E, Ekhtiari S, Bozzo A, Bhandari M, Johal H. What is the best evidence for management of displaced midshaft clavicle fractures? A systematic review and network meta-analysis of 22 randomized controlled trials. Clin Orthop Relat Res 2020; 478(2): 392-402. doi: 10.1097/CORR.0000000000000986. PMID: 31574019; PMCID: PMC7438117. DOI: https://doi.org/10.1097/CORR.0000000000000986

Ban I, Madsen C M, Brix M. Klavikelfraktur – Korte Kliniske retningslinjer [in Danish]. Orthopaedic Society (DOS) 2012. Available from: https://www.ortopaedi.dk/kliniske-retningslinjer/

Celestre P, Roberston C, Mahar A, Schwartz A, Nowak M, Lee T Q. Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma 2008; 22(4): 241-7. doi: 10.1097/BOT.0b013e31816c7bac DOI: https://doi.org/10.1097/BOT.0b013e31816c7bac

Fridberg M, Ban I, Issa Z, Kristiansen B. Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in 105 consecutive cases. Int Orthop 2013; 37(4): 689-92. doi: 10.1007/s00264-013-1793-9 DOI: https://doi.org/10.1007/s00264-013-1793-9

Ban I, Troelsen A, Christiansen D H, Brix M. Overtreatment of displaced midshaft clavicle fractures. Acta Orthop 2016; 87(6): 541-5. doi: 10.1080/17453674.2016.1191275 . DOI: https://doi.org/10.1080/17453674.2016.1191275

Court-Brown C M, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37(8): 691-7. doi:10.1016/j.injury.2006.04.130. DOI: https://doi.org/10.1016/j.injury.2006.04.130

Published

2025-01-28

How to Cite

Tryggedsson, I., Viberg, B., Gundtoft, P. H., Ban, I., Overgaard, S., Maleitzke, T., & von Keudell, A. (2025). Increasing incidences and changes in treatment trends of clavicle fractures in adults during 2 decades in Denmark: a nationwide study on data from the Danish National Patient Registry. Acta Orthopaedica, 96, 135–141. https://doi.org/10.2340/17453674.2025.43000