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

Abstract

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.

Keywords: clavicle fracture; conservative treatment; patient satisfaction; triangular bandage; two-point sling.