Refracture after locking compression plate removal in displaced midshaft clavicle fractures after bony union: a retrospective study

Abstract

Background: A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods: We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group.Results: There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6–210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions: This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.

Efficacy of intramedullary bridge fixation for midshaft clavicle fractures: a retrospective analysis of a novel technique

“…In contrast, plate fixation, an eccentric fixation approach, changes the original mechanical transmission mechanism of the clavicle, leading to significant stress shielding [ 38 ]. Moreover, the high stiffness of the plate and the sustained stress shielding effect during the later stages of fracture healing affect callus remodeling and might cause delayed fracture healing and reduce bone hardness after healing, potentially resulting in refracture after plate removal [ 39 , 40 ].…”

Efficacy of Intramedullary Bridge Fixation for Midshaft Clavicle Fractures: A Retrospective Analysis of a Novel Technique

“…In contrast, plate xation, an eccentric xation approach, changes the original mechanical transmission mechanism of the clavicle, leading to signi cant stress shielding [34]. Moreover, the high stiffness of the plate and the sustained stress shielding effect during the later stages of fracture healing affect callus remodeling, might cause delayed fracture healing, and reduce bone hardness after healing, potentially resulting in refracture after plate removal [35][36].…”

“…A total of 78 patients with mid-clavicle fractures were treated in our hospital from June 2020 to October 2022, of which 10 opted for conservative treatment and 5 were lost to follow-up. Based on the exclusion and inclusion criteria, a total of 63 patients were included in this study, of which 35…”

Comparison of a 2.7-mm and 3.5-mm locking compression plate for ulnar fractures: a biomechanical evaluation

“…Given the subcutaneous position of the fixation plates in the ulna, the use of smaller plates, such as the 2.7-mm LCP in this study, will reduce implant prominence. 32 Furthermore, the flexibility of these plates and the smaller size of the screw holes may be beneficial in promoting bone healing and mitigate the risk of refracture, should removal be required. 33 Currently, 3.5-mm plates are considered the standard of care for diaphyseal ulnar fracture fixation.…”