Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

TO THE EDlTOR

I read with great interest the retrospective study on the national rates of readmission and reoperation after open reduction internal fixation (ORIF) of midshaft clavicle fractures in adolescents by Carrillo[1], published in your esteemed journal in December 2021 issue.

I agree with the authors that there is a need to identify the national readmission and reoperation rates following ORIF of midshaft clavicle fractures in adolescents. Most clavicular fractures in adolescents have been typically treated nonoperatively, especially those affecting the mid-shaft of the clavicle[2,3]. In adolescents, there remains a major controversy over whether surgical treatment of clavicle shaft fractures improves the clinical outcomes in the same way it does in adults[4].

The following is an annotated1 version of the fairy tale. I recommend reading the entire story before exploring the annotations2, especially if you have not read the tale recently.

For the purpose of Carrillo[1] study, the authors utilized the Healthcare Cost and Utilization Project State Inpatient Database (SID) for the years 2005-2012 in Florida and 2005-2009 in California. This database includes inpatient discharge records from community hospitals in those states.

For identification of patient cohort, the authors used two codes. The first code is CPT 23515 code, which by definition refers to (Open treatment of clavicular fracture, includes internal fixation when performed). However, the other code used by the authors is ICD-9 CM 79.39 code, which refers to (open reduction of fracture with internal fixation, other specified bone), which means that this code is not specific at all to the clavicular fractures. Therefore, I am afraid the authors included in the study adolescent patients with fractures in other body bones, other than clavicular fractures.

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Mesregah MK revised the literature, collected data, wrote and revised the manuscript.

Nonoperative care is the successful historical treatment and the current safest treatment for midshaft clavicular fractures in adolescents. Operative care is overused in adolescents for clavicle fractures. To better assess the operative management, there is a need to conduct multiple prospective randomized studies or large comparative database studies.

All the authors declare that they have no conflict of interest.

FOOTNOTES

The authors also reported that 11 (3.3%) patients were readmitted within 90 d of surgery. However, this low rate is not clinically important as those 11 patients may have been admitted for other reasons unrelated to the index surgery.

Also note that this princess must prove her nobility through her physical sensitivity, not through her ability to fit a ring or slipper16 like her Donkeyskin and Cinderella counterparts. The test is a physical one, but quite unlike the other well-known tests of fitting into articles of clothing.Return to place in story.

Moreover, the authors identified only 334 clavicle fractures in adolescents managed operatively. This number is considered low to determine readmission and reoperation rates in large database studies such as SID. The authors should at least have used SID for years up to 2020 in both states.

Mohamed Kamal Mesregah 0000-0002-8047-9159.

Egypt

Liu JH

Later in life, I wondered how she could know so much about me that I did not know about myself. She knew even though my marks were average in school, that I was just bored but smart enough. She believed in me even when I made mistakes that caused others to shudder10. She wanted me to be more than she had been, when I thought she was everything I wanted to be.

The plane? Dana asked. Who cares about the plane? How could you be so cold? That was an old man; he could have been your grandfather! How would you like it if everyone just stepped over your grandfather and went on their way?

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Liu JH