JAAOS - 2026-08-20 - Journal Article
AAOS Appropriate Use Criteria Summary: Treatment of Mid-Shaft Clavicle Fractures.
Lack WD, Baxi O, Ellis HB, Krause B, Murray J, Sevarino K, Schulte DM, New Collective Author
Topics
Key Takeaway
The AAOS AUC panel rated surgical versus nonsurgical treatment across 96 mid-shaft clavicle fracture scenarios, producing appropriateness designations (Appropriate, May Be Appropriate, Rarely Appropriate) to guide clinical decision-making.
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Summary
The AAOS convened a writing panel to construct 96 clinical scenarios for mid-shaft clavicle fractures incorporating fracture characteristics, displacement, and patient factors, then had a separate multidisciplinary rating panel score each scenario on a 9-point appropriateness scale. Treatments were designated Appropriate (median 7–9), May Be Appropriate (median 4–6), or Rarely Appropriate (median 1–3). The output is a structured decision framework rather than primary outcome data.
Key Limitation
The appropriateness ratings are consensus-derived and not validated against actual patient outcomes, so they may perpetuate existing evidence gaps rather than resolve them.
Original Abstract
The American Academy of Orthopaedic Surgeons (AAOS) has developed an Appropriate Use Criteria (AUC) for the Treatment of Mid-Shaft Clavicle Fractures. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop criteria to determine the appropriateness of surgical and nonsurgical treatment in patients who have suffered a mid-shaft clavicle fracture. The Appropriate Use Criteria for the Treatment of Mid-Shaft Clavicle Fractures were derived by identifying clinical indications typical of patients who have suffered a mid-shaft clavicle fracture. These indications were most often variables observable by the clinician, including symptoms or results of diagnostic tests. In addition, "human factor" (eg, activity level or demographic variables) can be considered. The 96 patient scenarios and two treatments were developed by the writing panel, a group of clinicians who are specialists in this Appropriate Use Criteria topic. Next, a separate, multidisciplinary rating panel (made up of specialists and nonspecialists) rated the appropriateness of treatment for each patient scenario using a 9-point scale to designate a treatment as "Appropriate" (median rating, 7 to 9), "May Be Appropriate" (median rating, 4 to 6), or "Rarely Appropriate" (median rating, 1 to 3).