Objectives To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults. power difference between nonoperative treatment and ORIF was greater than 0.034 (base-case difference 0.014). Short-term disutility associated with fracture healing also affected cost-effectiveness, with the cost per QALY gained for ORIF falling below $50,000 when the power of a fracture treated nonoperatively prior to union was less than 0.617 (base-case power 0.706) or when nonoperative treatment increased the time to union by 20 weeks (base-case difference 12 weeks). Conclusions The cost-effectiveness of ORIF after acute clavicle fracture depended around the sturdiness of functional advantage for ORIF compared to nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had favorable value compared with many accepted health interventions. INTRODUCTION Fractures of the clavicle are common injuries, representing 4% of all fractures and occurring with an incidence of 64 per 100,000/12 months.1,2 Approximately 70% of clavicle fractures involve the midshaft, with males accounting for 70% of these fractures.3 Given that the average age of a patient sustaining a midshaft clavicle fracture is 33 years, any functional deficit associated with the injury has the potential for substantial economic impact. Traditionally, midshaft clavicle fractures have been treated nonoperatively with either a sling or figure-of-eight harness. The classic literature suggested that this nonunion rate Silmitasertib for clavicle fractures was under one percent and that very few patients had long term functional deficits related to the fracture.4,5 However, more recent studies of nonoperative treatment of displaced midshaft clavicle fractures have demonstrated nonunion rates of 13C15% and a 20C25% decrease in shoulder and arm strength at five year follow-up.6C9 These findings have prompted surgeons to reconsider operative treatment of these injuries. Open reduction and internal fixation (ORIF) of the clavicle has typically been reserved for fractures that are open, threaten the overlying skin or go onto nonunion following nonoperative treatment. However, a recent randomized controlled trial (RCT) comparing initial ORIF to nonoperative treatment for displaced, midshaft clavicle fractures in adults exhibited that ORIF resulted in significantly better outcomes as measured by the Constant shoulder score Silmitasertib and the Disabilities of the Arm, Shoulder and Hand (DASH) scale out to one year.10 In addition, the complications associated with ORIF of the MCM7 clavicle were uncommon and relatively benign (the majority related to hardware or superficial infection).9,10 Silmitasertib Given these findings, orthopaedic surgeons must now decide if operative treatment of displaced, midshaft clavicle fractures should be offered to patients as initial treatment. Operative treatment of all displaced, midshaft clavicle fractures would substantially increase the cost of treating this common injury. In addition, it is unclear if the functional benefits of medical procedures outweigh the surgical risks and justify the costs associated with operative treatment. As a result, this study was performed to determine the cost-effectiveness of ORIF compared to nonoperative treatment of displaced, midshaft clavicle fractures in adults. The next section offers a brief introduction to cost-effectiveness analysis for those unfamiliar with it. Introduction to Cost-Effectiveness Analysis Cost-effectiveness analysis (CEA) aims to determine the cost to society for the incremental health benefit derived from an intervention that is more costly than an alternative, less effective treatment. In order to compare the cost-effectiveness of a wide variety of treatments across many medical specialties, a universal scale of health must be used to measure preference for health outcomes. Silmitasertib In cost-effectiveness analysis, the quality-adjusted life year (QALY), which combines both length and quality of life in a single number is the Silmitasertib recommended measure of health benefit. To estimate QALYs, a (QALYs) associated with an intervention. The advantage of QALYs is usually that they allow for the comparison of very different health says across medical disciplines. The other half of the cost-effectiveness equation is the cost. While an intervention typically produces a health benefit, that benefit comes at a cost to society. Determining the cost of an intervention is usually challenging, so many cost-effectiveness analyses use gross costing based on common reimbursements for different procedures. After identifying.