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Injury. 2016 Jun;47(6):1248-52. doi: 10.1016/j.injury.2016.02.005. Epub 2016 Feb 17.

Complications associated with operative fixation of acute midshaft clavicle fractures.

Author information

1
Nepean Hospital, Sydney, Australia. Electronic address: saeedasadollahi@yahoo.com.
2
Northern Hospital, Melbourne, Australia. Electronic address: raphaelhau@hotmail.com.
3
University Hospital Geelong and School of Medicine, Deakin University, Geelong, Australia. Electronic address: richardpage@geelongortho.com.au.
4
Department of Surgery, University of Melbourne, Epworth Hospital, Melbourne, Australia. Electronic address: orthovic@gmail.com.
5
Department of Orthopaedics, The Alfred Hospital, Melbourne, Australia. Electronic address: ere@bigpond.net.au.

Abstract

INTRODUCTION:

The aim of this study was to review the complication rate and profile associated with surgical fixation of acute midshaft clavicle fracture in a large cohort of patients treated in a level I trauma centre.

PATIENTS AND METHODS:

We identified all patients who underwent surgical treatment of acute midshaft clavicle fracture between 2002 and 2010. The study group consisted of 138 fractures (134 patients) and included 107 men (78%) and 31 women (22%); the median age of 35 years (interquartile range (IQR) 24-45). The most common mechanism of injury was a road traffic accident (78%). Sixty percent (n=83) had an injury severity score of ≥15 indicating major trauma. The most common fracture type (75%) was simple or wedge comminuted (2B1) according to the Edinburgh classification. The median interval between the injury and operation was 3 days (IQR 1-6). Plate fixation was performed in 110 fractures (80%) and intramedullary fixation was performed in 28 fractures (20%). There were 85 men and 25 women in the plate fixation group with median age of 35 years (IQR 25-45) There were 22 men and six women in the intramedullary fixation group with median age of 31 years (IQR 24-42 years). Statistical analysis was performed using independent sample t test, Mann Whitney test, and Chi square test. Significant P-value was <0.05.

RESULTS:

The overall incidence of complication was 14.5% (n=20). The overall nonunion rate was 6%. Postoperative wound infection occurred in 3.6% of cases. The incidence of complication associated with plate fixation was 10% (11 of 110 cases) compared to 32% associated with intramedullary fixation (nine of 28 cases; P=0.003). Thirty-five percent of complications were related to inadequate surgical technique and were potentially avoidable. Symptomatic hardware requiring removal occurred in 23% (n=31) of patients. Symptomatic metalware was more frequent after plate fixation compared to intramedullary fixation (26% vs 7%, P=0.03).

CONCLUSIONS:

Intramedullary fixation of midshaft clavicle fracture is associated with a higher incidence of complications. Plate fixation is associated with a higher rate of symptomatic metalware requiring removal compared to intramedullary fixation. Approximately one in three complications may be avoided by attention to adequate surgical technique.

KEYWORDS:

Clavicle fracture; Complication; Midshaft

PMID:
26994518
DOI:
10.1016/j.injury.2016.02.005
[Indexed for MEDLINE]
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