Dafang Zhang - ۱ Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA ۲ Harvard Medical School, Boston, MA, USA
Brandon E. Earp - ۱ Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA ۲ Harvard Medical School, Boston, MA, USA
George Dyer - ۱ Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA ۲ Harvard Medical School, Boston, MA, USA

Background: The objectives of this study were to (۱) identify factors associated with skin tenting in displaced midshaftclavicle fractures and (۲) analyze individual surgeon variation in this diagnosis.Methods: A retrospective cohort study was performed at two Level I trauma centers of ۳۹۶ patients with displacedmidshaft clavicle fractures treated by ۴۷ surgeons with open reduction internal fixation from January ۲۰۱۰ to March۲۰۱۹. Our main outcome measure was skin tenting, as diagnosed by the treating surgeon and used as an indicationfor surgical treatment.Results: Skin tenting was diagnosed by the treating surgeon in ۳۴ out of ۳۹۶ patients (۹%) with displaced midshaftclavicle fractures. Multivariable logistic regression analyses showed that lower BMI (P=۰.۰۰۲) and fracture shortening(P=۰.۰۳) were independently associated with skin tenting in displaced midshaft clavicle fractures. There was widevariation among surgeons in the rate of diagnosis of skin tenting, ranging from ۰% to ۴۱% prevalence of skin tentingdepending on the treating surgeon (p <۰.۰۰۰۱).Conclusion: Although lower BMI and greater fracture shortening were associated with skin tenting, the diagnosisis subjective. We found wide variation in the diagnosis of skin tenting, even among surgeons within a singlemetropolitan area.Level of evidence: III

Body mass index, displaced clavicle fracture, Midshaft clavicle fracture, skin tenting, surgeon variation