Factors affecting duration of inability to work after intramedullary stabilization of displaced midshaft clavicular fractures.

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 to 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 2 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 eligibility criteria, with DIW 35.1 ±31.1 days. Operative duration, physical workload, and physical therapy prolonged DIW (p<0.001). In contrast, enrollment in private health insurance reduced 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 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 DIW after IMS of DMCF.

LEVEL OF EVIDENCE: IV - retrospective observational cohort study with no control group.