Prognostic Factors for Reoperation After Plate Fixation of the Midshaft Clavicle

Schemitsch, Laura A.; Schemitsch, Emil H.; Kuzyk, Paul; McKee, Michael D.

doi:10.1097/bot.0000000000000331

Cited by 47 publications

(20 citation statements)

References 14 publications

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“…Our observed implant removal rates (49% of ALCPs and 57% of RLCPs) are comparable to the results of studies by Schemitsch (n = 153, 38% removed of mixed implant types) [37] and VanBeek (n = 42, 64% non-anatomical and 11% anatomical plates removed, but with shorter overall follow-up) [24]. It is worth noting that Schemitsch also found shorter body height (< 175 cm) to be a risk factor for implant removal.…”

Section: Biomechanical Studies Have Demonstrated a Considerable Advansupporting

confidence: 86%

Does switching to anatomically pre-contoured clavicle plates lead to fewer failures and removals than reconstruction plates? - a propensity score matched retrospective cohort study of 114 patients

Fang

Liu

Yee

et al. 2019

Preprint

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Abstract Background: Plate fixation is frequently used to treat displaced midshaft clavicular fractures, however the ideal plate choice remains subject to discussion; reconstruction locking compression plates (RLCPs) are cheaper and can be easily contoured, whereas anatomically pre-contoured locking compression plates (ALCPs) are thought to provide better stability and therefore lower rates of mechanical failure. Objective: To compare the incidence of mechanical failures, functional and radiological outcomes in patients with midshaft clavicular fractures treated with ALCPs versus RLCPs. Methods: A propensity score matched retrospective cohort study was conducted across two trauma centers. 114 consecutively recruited patients with displaced midshaft clavicular fractures, who were treated with plate fixation and had a minimum follow-up of 6 months, were matched on gender, age, fracture grading, energy of injury, and fracture location. The resulting groups included 53 ALCP-treated fractures and 53 matched controls treated with RLCPs. Results: During a mean follow-up of 20.5 months, there were no implant deformities in the ALCP group whereas the RLCP group had 6 patients (11.3%, p=0.012) with implant deformities (5 occurrences of plate bending with fracture union, and 1 plate breakage with nonunion). Despite the higher rate of plate deformities in the RLCP group, there were no statistically significant differences in number of patients recovering full shoulder range of motion (ALCP 90.6%, RLCP 88.7%, p=0.751), incidence of rest pain (ALCP 13.2%, RLCP 9.4%, p=0.542), or implant removals (ALCP 49.1%, RLCP 56.6%, p=0.439). Conclusion: ALCPs may be superior to RLCPs in terms of implant stability but appear to produce similar clinical results. Keywords: anatomical plate; locking plate; clavicle fracture; plate fixation; midshaft clavicle

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Section: Biomechanical Studies Have Demonstrated a Considerable Advansupporting

confidence: 86%

Does switching to anatomically pre-contoured clavicle plates lead to fewer failures and removals than reconstruction plates? - a propensity score matched retrospective cohort study of 114 patients

Fang

Liu

Yee

et al. 2019

Preprint

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“…The treatment of Cierny-Mader type 1 is especially difficult, the primary stability of the fracture is very important, the ACC rods with DDS provide stability as well as delivering antibiotics [17]. The tibia is the most frequent site of an open fracture and the most common site of PPO [6,7]. Although the infection rate after open reduction and internal fixation of closed fractures is significantly lower [8], the incidence of osteomyelitis after open fractures is reported to be 2-16%.…”

Section: Discussionmentioning

confidence: 99%

A Modified Management of Implant Associated Postoperative Osteomyelitis With Cierny-Mader Type

Tan

Pan

et al. 2020

Preprint

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Background: No standardized protocol has been suggested in the treatment of postoperative osteomyelitis. Our team evaluates the clinical efficacy of the modified tactics of implant associated postoperative osteomyelitis patients according to Cierny-Mader type. Methods: 95wounds were reviewed from March 2009 to February 2016 in our hospital. 61 wounds were treated by the modified algorithm as following: Stable hardware + bone not healed Cierny–Mader 1 type = remove hardware, temporary stabilize; Stable hardware + bone not healed Cierny–Mader 2 type = retain hardware ; Stable hardware + bone not healed Cierny–Mader for type 3 and type 4 = remove hardware, temporary stabilize/ Ilizarov technique; Unstable hardware + bone not healed = remove hardware, temporary stabilize/ Ilizarov technique; Stable hardware + bone healed = remove hardware. 34 wounds were treated by the conventional algorithm. Autodermoplasty, flap transfer, myocutaneous flap and other methods including antibiotic irrigation and drug delivery system were used in wound repair. Results: The patients treated with modified algorithm had a significantly reduced recurrence (P＜0.01) , and increased results of negative bacterial cultures (P＜0.01), but however observed a decrease in the number of retained hardware cases (P＜0.05) . For those treated with tissue reconstruction, there was no significantly (P＞0.05) comparing with the conventional group. Conclusions: The modified technique for the implant associated postoperative osteomyelitis according to the stability of the hardware and Cierny-Mader type represent a good clinical efficacy in the management of postoperative osteomyelitis. This procedure is simple and shows promising results, more clinical evidence is needed to confirm the existing findings and optimize the treatment of postoperative osteomyelitis. Key Words: Osteomyelitis, Postoperation, Implant

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“…The most important prognostic factors for reoperation following mid shaft clavicle fractures are non-union, infection and hard ware prominence/implant removal, among above implant removal is the most important prognostic factor. It ranges from 18 to 27% among various studies [16,17] In our study implant removal was done in 3 patients due to hardware prominence, this hardware prominence can be reduced by precontoured plates. [18] In summary we believe that open reduction and internal fixation of fracture of mid shaft clavicle gives excellent results in terms of functional outcome and low complication rates and patient satisfaction.…”

Section: Original Articlementioning

confidence: 99%

A Prospective Study of Surgical Management of Displaced Middle Third Clavical Fracture by Plate Osteosynthesis

Patri¹,

Padya²,

P³

et al. 2015

jebmh

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BACKGROUND: Clavicle fractures are usually known for its conservative treatment, but for displaced middle third comminuted fractures (Robinson type 2B) plate osteosynthesis is a promising option. AIM: To evaluate the functional outcome of middle third clavicular fracture (2B1, and B2 Robinson classification) in 30 patients managed with Open reduction and internal fixation with plate and screw. METHODS AND MATERIAL: We performed a prospective study between Jan 2009 to May 2012 of 30 acute displaced comminuted middle third clavicle fractures in adults which were treated with plate osteosynthesis. There were 22 males, 8 females, the mean age of the patient was 35.6 years and 10 patients had associated injuries and average follow up was 18 month, minimum of 6 months. RESULTS: Union was achieved in 12-16 weeks. Post operatively 2 patients had superficial infection, 3 patients had scar hypertrophy, 3 Patients had hard ware prominence, no patients had hardware failure and none of the patients had deep infection. The average constant score was 96 and patients were relatively satisfied with the treatment. CONCLUSION: Plate Osteosynthesis for displaced middle third shaft fracture in adults gives excellent results.

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Prognostic Factors for Reoperation After Plate Fixation of the Midshaft Clavicle

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 47 publications

References 14 publications

Does switching to anatomically pre-contoured clavicle plates lead to fewer failures and removals than reconstruction plates? - a propensity score matched retrospective cohort study of 114 patients

Does switching to anatomically pre-contoured clavicle plates lead to fewer failures and removals than reconstruction plates? - a propensity score matched retrospective cohort study of 114 patients

A Modified Management of Implant Associated Postoperative Osteomyelitis With Cierny-Mader Type

A Prospective Study of Surgical Management of Displaced Middle Third Clavical Fracture by Plate Osteosynthesis

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