Comparison of two-point sling vs. triangular bandage on patient satisfaction for conservative treatment in clavicle fractures: a randomized controlled trial.

BACKGROUND AND

IMPORTANCE

Clavicle fractures account for about 3% of all fractures in adults, and have reportedly good outcomes with conservative treatment for lateral and mid-shaft clavicle fractures. Whether the use of a simple two-point sling or a triangular bandage should be the optimal first choice procedure is unknown.

OBJECTIVES

The objective of this study was to compare patient satisfaction after 1 week in patients with lateral or mid-shaft clavicle fractures treated with a two-point sling vs. a triangular bandage.

DESIGN, SETTING, AND

PARTICIPANTS

In this single center, randomized controlled trial, patients with acute, isolated and conservatively treated clavicle fractures were included. The primary endpoint was patient satisfaction at 1 week, measured with the Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology (D-QUEST) questionnaire. Secondary outcomes were pain and functional recovery at different time points, measured with the visual analogue scale and Disabilities of the Arm, Shoulder, and Hand scores, respectively.

INTERVENTION: Patients were randomized for immobilization with a triangular bandage or a two-point sling.

OUTCOMES MEASURE AND ANALYSIS: Differences in numerical variables were calculated using the unpaired t -test or Mann-Whitney U test. Categorical variables were analyzed using the Chi-Square test. Absolute effect size and 95% confidence interval (CI) were calculated, and a minimal clinically important difference of 0.25 was defined.

RESULTS

Between August 2020 and February 2023, 110 patients were included in this study. After excluding patients who underwent surgery or were lost to follow-up, 68 patients were analyzed. Statistically and clinically significant differences were found in patient satisfaction scores at week 1 after trauma, in favor of the two-point sling (D-QUEST scores of 2.48 (±0.48) vs. 3.20 (±0.45), absolute mean difference 0.72 (CI, 0.49-0.95). There was no significant difference in pain and disability related secondary outcomes.

CONCLUSIONS

This study identified a significant difference in patient satisfaction favoring a two-point sling compared to a triangular bandage 7 days posttrauma.