Complications associated with plate fixation of acute midshaft clavicle fractures versus non-unions

Abstract

An important consideration when counselling patients with midshaft clavicle fractures is whether operative treatment of non-union, if it develops after non-operative treatment, is associated with higher complication rate than acute fracture fixation. The aim of this study is to compare complications and re-operations after open reduction and plate fixation for acute midshaft clavicle fractures versus non-unions. The study was retrospective. There were 90 patients in the acute fixation group and 20 patients in the non-union group. The mean follow-up was 8 and 15 months, respectively, Logistic regression analysis was used to assess whether 'non-union surgery' was a predictor of complications and re-operations. Of 90 patients, 23 had complications in acute fixation group. Of 20, 7 developed 8 complications in the non-union group (p = 0.4). Of 90, 12 required re-operations in the acute fixation group compared to 5/20 requiring 7 re-operations in the non-union group (p = 0.19). When any complication or re-operation was considered, 'non-union surgery' was not significant predictor for complications (p = 0.78) or re-operations (p = 0.99). The complication and re-operation rates were not higher after non-union surgery compared to acute fracture fixation and were mostly related to persistent delayed or non-union, rather than operative complications. When counselling patients about treatment of midshaft clavicle fractures, a 'higher complication rate after surgery for non-union, should it happen' should not be an argument against non-operative treatment.

Clinical Evaluation of the Treatment of Clavicle Fractures: Intramedullary Nail × Plate

“…17 In our study, the complication rate was 20%, being similar to other studies. [18][19][20][21] In a meta-analysis conducted by Wang et al, 17 the frequency of postoperative complications was similar in both forms of fixation. Based on our results, the group fixed with plate presented the highest number of complications (n = 9), but without significant and 14.4 mm for nail.…”

Plate fixation of clavicle fractures: comparison between early and delayed surgery

“…A single-center study from the United Kingdom including 20 patients with nonunion found similar results, with more complications compared with acute surgery and a tendency toward more frequent reoperations. 10 By use of logistic regression, however, these findings were not significant, potentially because of the limited number of patients included.…”

“…Currently, data comparing acute surgery and surgery for nonunion are scarce, and the results are conflicting. 5,8,10 Our study had 2 main objectives: First, we wanted to evaluate our step-wise treatment protocol for patients with clavicle fractures to determine our success rate of conservative treatment. Second, we evaluated the incidence of complications after clavicle plate fixation in patients undergoing acute surgery vs. delayed surgery, with specific attention regarding patients with postoperative AC joint dislocation.…”

Fracture nonunion in long bones: A literature review of risk factors and surgical management

“…There is increasing evidence that delayed primary fixation in the first three months post-injury is a valid alternative without an apparent increase in complications [47][48][49] . Delayed recovery following non-operative management may predict union and can be accurately judged on a patient reported QuickDASH score and other objective clinical features at six weeks post-injury [ 50 , 51 ].…”