Skin Tenting in Displaced Midshaft Clavicle Fractures

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA 2 Harvard Medical School, Boston, MA, USA

Abstract

Background: The objectives of this study were to (1) identify factors associated with skin tenting in displaced midshaft
clavicle fractures and (2) analyze individual surgeon variation in this diagnosis.
Methods: A retrospective cohort study was performed at two Level I trauma centers of 396 patients with displaced
midshaft clavicle fractures treated by 47 surgeons with open reduction internal fixation from January 2010 to March
2019. Our main outcome measure was skin tenting, as diagnosed by the treating surgeon and used as an indication
for surgical treatment.
Results: Skin tenting was diagnosed by the treating surgeon in 34 out of 396 patients (9%) with displaced midshaft
clavicle fractures. Multivariable logistic regression analyses showed that lower BMI (P=0.002) and fracture shortening
(P=0.03) were independently associated with skin tenting in displaced midshaft clavicle fractures. There was wide
variation among surgeons in the rate of diagnosis of skin tenting, ranging from 0% to 41% prevalence of skin tenting
depending on the treating surgeon (p <0.0001).
Conclusion: Although lower BMI and greater fracture shortening were associated with skin tenting, the diagnosis
is subjective. We found wide variation in the diagnosis of skin tenting, even among surgeons within a single
metropolitan area.
Level of evidence: III

Keywords

References

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The Archives of Bone and Joint Surgery
Volume 9, Issue 4
July and August 2021
Pages 418-422

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History

  • Receive Date: 14 December 2019
  • Revise Date: 14 September 2020
  • Accept Date: 17 September 2020

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