Surgical fixation of clavicle fractures in the elderly: utilization and compensation over two decades

To analyze trends in utilization of operative and non-operative treatment of midshaft clavicle fractures in the Medicare population over a 23-year period. An additional aim was to identify patterns in physician reimbursement for both treatment modalities over the same period.

Retrospective analysis of publicly available data from the Medicare Part B National Summary Data Files. The study includes the Medicare population from 2000 to 2022 undergoing treatment for closed clavicular shaft fractures based on Current Procedure Terminology (CPT) codes. Primary outcomes were the utilization of operative versus non-operative treatment of clavicle fractures in addition to trends in physician reimbursement for both modes of treatment.

From 2000 to 2022, a total of 308,553 clavicle fractures were treated in the national Medicare population. Over this 23-year period, non-operative treatment increased by 34% and operative treatment increased by 807% without adjusting for Medicare enrollment. When adjusted for Medicare enrollment, non-operative treatment decreased by 19% and operative treatment increased by 445%. When adjusted for inflation, average physician reimbursement for non-operative treatment decreased by 19%, whereas reimbursement for operative management increased by 40%.

Operative treatment of clavicle fractures in the Medicare population increased substantially over this time frame; however, non-operative treatment remains the predominant treatment choice. Physician reimbursement was noted to decrease for non-operative treatment, while reimbursement for operative treatment has outpaced inflation, which is unique compared to many orthopedic procedures.