Infection After Surgical Reconstruction of a Clavicle Fracture Using a Reconstruction Plate: A Report of Seven Cases

Abstract

Mid-shaft clavicle fractures have traditionally been treated conservatively, although this has been associated with non-union and unsatisfactory shoulder function. The preferred approach is plate fixation, with a reconstruction plate for open reduction and internal fixation. Infection is a potential complication after such surgery, with rates of 0.4-7.8% reported in the literature. In our cases, an infection rate of 4.9% (7 of 142 patients) was noted; five of the seven patients suffered from acute postoperative infection within 1 month of surgery. The average time to presentation with an infection was 28 (23-32) days, with signs and symptoms of wound dehiscence in one patient and sinus discharge in four patients. Two patients suffered from subacute infections, with durations of 72 and 103 days, presenting with local heat and radiographic findings of screw loosening. Six of the cases healed with primary bony union after intensive debridement and early removal of the implants.

Comparison of Plates versus Intramedullary Nails for Fixation of Displaced Midshaft Clavicular Fractures

“…19 In a 2008 study from Taiwan, in a population comparable with ours, the infection rate was 4.9% (7 of 142) in patients receiving ORIF and plate fixation. 20 Thus, in general, we had similar treatment outcomes but a higher percentage of complications.…”

Systematic review of the complications of plate fixation of clavicle fractures

“…Asterisk excluded were one case report [29] and two studies in which there was no clear distinction made between postoperative complications after acute fractures and nonunions [9, 14]. Seven studies included complicated fractures and made no distinction with uncomplicated fractures when describing complications [3, 8, 15, 18–20, 32]. One study was a surgical technique paper [2], one study only reported outcomes and no complications [28], two studies had no clear definition of indication for surgery [1, 38] and, finally, two studies included different kinds of clavicle fractures (pathological, distal and nonunions) [11, 26]…”

Minimally Invasive Fixation of Displaced Midclavicular Fractures With Titanium Elastic Nails

“…These plates need to be contoured to fit the complex S-shape of the clavicle with a larger skin incision and extensive soft tissue stripping, both leading to potential complications. 10 6 compared the patient-and surgeon-based outcomes between the nonoperative treatment and plate fixation of completely displaced midclavicular fracture in a multicenter, randomized clinical trial. Although the group of plate fixation had superior functional scores and higher patient satisfaction, they also concluded that the most complications after plate fixation in midclavicular fractures were hardwarerelated (plate irritation and/or prominence and wound infection).…”

“…However, several complications, including infection, wound breakdown, nonunion, implant failures, poor cosmetic, and local skin numbness, have been reported. [10][11][12][13][14] In a multicenter, randomized clinical trial, McKee et al 6 concluded the complications in the group of plate fixation of the midclavicular fractures tended to be hardware-related such as plate irritation and/or prominence requiring removal and wound infection and/or dehiscence. To prevent plate irritation and limit soft tissue stripping, intramedullary devices have been applied to fix the midclavicular fractures.…”