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

Abstract

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.

Selective Glenohumeral external rotation deficit – sequelae of post-ORIF deltoid adhesions after treatment of the proximal humerus fracture

“…Implant-related complications, such as irritation, are relatively common and require the removal of the implant [8,18,[34][35][36][37]. Improvements in shoulder function have been observed following implant removal in cases of proximal humerus fracture at the shoulder girdle [8,18].…”

Surgical treatment of Neer type II and type V lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study

“…Implant-related irritation and implant removal were analyzed using the series of questions developed by Hulsmans et al [ 21 ]. In the current study, all CHP implants were removed after a mean of 4.3 months, in line with previous studies recommending CHP removal after fracture consolidation [ 11 ].…”

“…Infection and re-fracture following implant removal were considered implant removal-related complications. Implant-related irritation and indication for implant removal were analyzed using a series of questions developed by Hulsmans et al [ 21 ]. Responses to these questions allowed categorization of implant removal into (1) routinely or on patient’s request without irritation or (2) patient’s request due to irritation.…”

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

“…The total complication ratio of this study was 7.9% in 101 participants, 5 numbness around the incision, 2 nonunion and 1 refracture post hardware removal. It was lower than most previous studies [9,7,11,27,31]. The damage of periosteum and blood supply during xation of lag screw might assume the main responsibility for the failures in traditional group.…”

“…However, placing lag screws almost always needed additional periosteal stripping to show enough space to perform. And most of the delayed union or nonunion come from unlimited stripping of periosteum and destroying of blood supply during operation [27,28,29]. Second, although compression of two fragments can be ensured by a lag screw, it is almost impossible for all multi-fragments to contact tightly.…”