Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison

Wijdicks, Frans-Jasper; Houwert, Roderick M.; Dijkgraaf, Marcel G. W.; Lange, Diederik de; Oosterhuis, K; Clevers, G. J.; Verleisdonk, Egbert-Jan M. M.

doi:10.1007/s00264-012-1615-5

Cited by 65 publications

(54 citation statements)

References 24 publications

(30 reference statements)

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“…2b) are the most frequently used implants [4]. Yet, in our clinic, surveys have revealed a relatively high complication rate with this plate, similar to those published by Wijdicks et al and Houwert et al [5,6]. Over a period of two years, five implant failures approximately three months postoperatively were observed (Fig.…”

Section: Introductionmentioning

confidence: 55%

Biomechanical comparison of the Locking Compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation

Eden

Hoelscher-Doht

Frey

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to characterise the biomechanical properties of the seven hole superior anterior clavicle LCP (locking compression plate) and to compare these with the properties of commonly applied implants used for the stabilisation of clavicular midshaft fractures such as the locking 7-and ten hole reconstruction plate. Methods Twenty-four synthetic clavicles were used. A transverse midshaft fracture was induced. The clavicles were fixed with angle stable clavicle LCPs, seven hole and ten hole reconstruction plates (n08 each). Twenty cycles of axial compression and torsion were performed for each sample, which was followed by 1,000 cycles of three point bending and ultimately bending to failure. Axial, torsional and cantilever bending stiffness were calculated from the data recorded. Results The clavicle LCP showed the highest overall stiffness compared to the seven and ten hole reconstruction plate. Significantly higher stiffness values were found for axial compression and external rotation. In the load-to-failure tests, the ten hole reconstruction plate especially showed early signs of plastic deformation, which might account for early plate insufficiency so frequently observed clinically. Conclusion The results indicate that the clavicle LCP, as compared to the reconstruction plates, leads to superior biomechanical stability in the treatment of midshaft clavicle fractures.

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Section: Introductionmentioning

confidence: 55%

Biomechanical comparison of the Locking Compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation

Eden

Hoelscher-Doht

Frey

et al. 2012

International Orthopaedics (SICOT)

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“…These patient-and surgeon-specific variables may explain the wide variation in irritation rates reported by others (9%-64%) [1,4,6,20,22,23]. Some surgeons consider irritation as discomfort coexisting with the treatment rather than a complication.…”

Section: Discussionmentioning

confidence: 99%

“…Reported irritation rates range from 9% to 44% after plate fixation and 9% to 62% after IM nailing. It often is treated by surgical implant removal (a second operation) [1,4,6,[20][21][22][23]. However, comparative studies or studies regarding the development of implant-related irritation with followup beyond the first year or two are scarce [1,4,14,19,23].…”

Section: Introductionmentioning

confidence: 99%

High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Hulsmans

Heijl

Houwert³

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Studies comparing plate with intramedullary nail fixation of displaced midshaft clavicle fractures show faster recovery in the plate group and implant-related complications in both groups after short-term followup (6 or 12 months). Knowledge of disability, complications, and removal rates beyond the first postoperative year will help surgeons in making a decision regarding optimal implant choice. However, comparative studies with followup beyond the first year or two are scarce. Questions/purposes We asked: (1) Does plate fixation or intramedullary nail fixation for displaced midshaft clavicle fractures result in less disability? (2) Which type of fixation, plate or intramedullary, is more frequently associated with implant-related irritation and implant removal? (3) Is plate or intramedullary fixation associated with postoperative complications beyond the first postoperative year?Methods Between January 2011 and August 2012, patients with displaced midshaft clavicle fractures were enrolled and randomized to plate or intramedullary nail fixation. A total of 58 patients with plate and 62 patients with intramedullary nails initially were enrolled. Minimum followup was 30 months (mean, 39 months; range, 30-51 months). Two patients (3%) with plate fixation and two patients (3%) with intramedullary nails were lost to followup. The QuickDASH was obtained at final followup and compared between patients who had plate fixation and those who had intramedullary nail fixation. Postoperative complications measured include infection, implant-related irritation, implant failure, nonunion, and refracture after implant removal. Indications for implant removal included implant-related irritation, implant failure, nonunion, patient's wish, or surgeon's preference. Results Between patients with plate versus intramedullary nail fixation, there were no differences in QuickDASH The institution of one or more of the authors (FJW, RMH, EJV) has received, during the study period, funding from the AO Foundation ((Dübendorf, Switzerland). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Conclusions After a mean followup of 39 months, disability scores were excellent. Major complications did not occur after the 1-year followup. A frequent and bothersome problem after both surgical treatments is implant-related irritation, resulting in high rates of implant removal, after 1 year. Future research could focus on analyzing risk factors for implant irritation or removal. Level of Evidence Level II, therapeutic study.

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“…But in the aspect of complications, titanium elastic nail showed superiority over plating. Wijdicks et al, in their study found that plating is associated with higher refracture, major revision surgery and implant failure in comparison to elastic stable nail [19].…”

Section: Author's Contributionsmentioning

confidence: 99%

Midshaft Clavicular Fracture and Titanium Elastic Intra-medullary Nail

Mishra

Gupta²,

Gaur

2014

JCDR

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Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison

Cited by 65 publications

References 24 publications

Biomechanical comparison of the Locking Compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation

Biomechanical comparison of the Locking Compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation

High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Midshaft Clavicular Fracture and Titanium Elastic Intra-medullary Nail

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