Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population

Abstract

Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors performed a retrospective analysis of active duty servicemembers who underwent open reduction and internal fixation of Neer type II distal clavicle fractures between October 17, 2007, and July 20, 2012, with a minimum of 2-year clinical follow-up. The electronic health record was queried to extract demographic features and clinical outcomes, primarily persistence of pain, removal of hardware, and postoperative return to high-level activity. A total of 48 patients were identified, with mean follow-up of 3.8 years. A total of 44% of patients underwent subsequent hardware removal. All fractures achieved radiographic union, and 35% of patients had persistence of symptoms. Patients who were treated with hook plating had a 3.64-fold higher risk of persistence of pain compared with those treated with conventional plating techniques. A total of 35% of patients successfully returned to full military function and completed a postoperative military deployment. Coracoclavicular reconstruction did not improve outcomes. Persistence of symptoms and requirement for hardware removal were not associated with the rate of postoperative deployment. Achieving excellent functional outcomes with open reduction and internal fixation of distal clavicle fractures remains a challenge. Where possible, conventional plate fixation should be considered over hook plate fixation. However, subsequent hardware removal and continuing shoulder pain do not preclude a return to high-level activity. [Orthopedics. 2018; 41(1):e117-e126.].

Outcomes, Union Rate, and Complications After Operative and Nonoperative Treatments of Neer Type II Distal Clavicle Fractures: A Systematic Review and Meta-analysis of 2284 Patients

“…Less frequently used PROMs—and therefore not analyzed in this study—were the Subjective Shoulder Value, Oxford Shoulder Score, and QuickDASH (used 7, 6, and 4 times, respectively). Three studies 15,17,37 used an unusual questionnaire, and 3 studies 11,30,68 did not use any PROM. The data of 1 study 72 were not adaptable for analysis owing to division of its population into subgroups.…”

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Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers

“…In regard to combat experiences, we found that combat injuries and stressful combat events were common (20.2% and 46.4%, respectively) and associated with new postdeployment pain. That combat experiences were determinants of new pain has been previously shown and is intuitive (physical injury and acute pain can transition into chronic pain), while PTSD and other psychiatric comorbidities are common correlates of pain . Herein, combat experiences were used as a surrogate for PTSD and other psychiatric comorbidities because these traumatic experiences typically precede the manifestation of psychiatric sequelae .…”