Risk factors for postoperative complications of displaced clavicular midshaft fractures

Abstract

Open reduction and internal fixation using a reconstruction plate for acute displaced clavicular midshaft fractures demonstrated satisfactory clinical outcomes and favorable bony union rates. However, hardware-related complications because of fracture pattern, nonunion, and inadequate surgical techniques require detailed consideration. Furthermore, when additional fixation is needed for comminuted fracture fragments, interfragmentary screw fixation is recommended before cerclage wiring.

Construct failure after open reduction and plate fixation of displaced midshaft clavicular fractures

“…The available literature also suggests that the reduced stiffness of the reconstruction plate seems to be accountable for less biomechanical stability than provided by other plates [10,14,15]. Eight percent of all reconstruction plates broke in our study, which is comparable with the 8.5 to 12.6% described in several other clinical studies [7,10,16]. However, in our study all broken reconstruction plates were used as a fracture bridging implant.…”

To Evaluate the Surgical Outcome of Non-Union Clavicle Using Plate and Slivers of Autologous Iliac Crest Corticocancellous Bone Graft

“…Lateral 1/3 rd fractures of the clavicle are difficult to treat due to their small size and about 45% of these end in delayed union and 30% may end up being non-union, 32 there was complete union in our cases and we used 3.5 mm AO LCP supplemented with bone graft. Seven out of 20 of our cases were either due to fixation failure or due to intact plate with non-union, three of them had cerclage wire along with the plate, the use of cerclage wire along with the plate is controversial with some studies showing increased risk of non-union 33,34 and others showing no risk of non-union if performed carefully with minimal soft tissue dissection. 35 Our study showed 100% results in 20 cases of non-union treated with open reduction and internal fixation with plate and bone grafting using the corticocancellous bone grafts from the iliac crest; (Fig.…”

Immediate Weight-bearing as Tolerated has Improved Outcomes Compared to Non–weight-bearing after Surgical Stabilisation of Midshaft Clavicle Fractures in Polytrauma Patients

“…Previous reports have indicated that union rates from operative management of clavicle fractures maybe near 100%; however, the complication rate from implant failure or loosening has been reported between 5e8%. 17,18 All patients available for follow-up went on to union at an average of 11.2 weeks in the WB group (range 9.1e13.0) versus 12.2 weeks in the NWB group (range 6.9e16.9), and no patients had hardware failure or loosening. Our results suggest that immediate WB does may not have an adverse effect on the union rate or hardware failure of operatively treated clavicle fractures.…”

“…26 The forces acting at the clavicle during crutch WB are likely a combination of axial 29 and bending, either cantilever or four point. 17,18 The clavicle fracture and plate composite also are unlikely to see the entire 313.6 N force transmitted from the glenohumeral joint during crutch WB secondary to muscular stabilisation as well as dissipation through the scapulothoracic articulation. While it remains speculative, we estimate that the end result of the individual components of these forces is substantially less than force needed to induce mechanical failure.…”