Plate fixation of midshaft clavicular fractures: patient-reported outcomes and hardware-related complications

Naimark, Micah; Dufka, Faustine L.; Han, Richard; Sing, David C.; Toogood, Paul; Benjamin, C.; Zhang, Alan L.; Feeley, Brian T.

doi:10.1016/j.jse.2015.09.029

Cited by 51 publications

(45 citation statements)

References 39 publications

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“…In the current study, QuickDASH scores improved marginally after 1 year, and were comparable to previously reported data after long-term followup [10,14,16]. Results of one study indicated that shoulder disability scores reached a steady state 1 year postoperatively [19].…”

Section: Discussionsupporting

confidence: 89%

“…Patients doing poorly or pursuing implant removal elsewhere may be less likely to respond to the questionnaires. Another 12% of their patients expressed a strong desire to have the plate removed [14], which is comparable to the 11% in this study.…”

Section: Discussionsupporting

confidence: 81%

“…Naimark et al [14] reported patient-reported outcomes after plate fixation of midshaft clavicle fractures and also completed an implant-related outcome survey in 73 patients. They reported a substantially lower overall plate removal rate compared with the rate in our study (15% versus 50%).…”

Section: Discussionmentioning

confidence: 99%

“…An explanation for the low major complication rates, like implant failure, could be that in half of the patients (16 in the plate group and 45 in the IM nail group) the implant had been removed before the 1-year followup [21]. Only a few studies have analyzed complications with followup beyond the first year after surgical treatment of displaced midshaft clavicle fractures [2,10,11,14]. Comparable to the current study, they reported low rates of infection, failure, and nonunion.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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