Skin Tenting in Displaced Midshaft Clavicle Fractures

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.