Risk factors for refracture after plate removal for midshaft clavicle fracture after bone union

Abstract

BackgroundOpen reduction and internal fixation (ORIF) with plates and screws is one of the treatment options for clavicle fractures. However, an additional operation for implant removal after union of the fracture is commonly performed due to a high incidence of hardware irritation. Despite union of the fracture, a subsequent refracture might occur after removal of the implant which requires additional surgeries for fixation. This study aims to determine the risk factors associated with refracture of the clavicle after hardware removal.MethodsWe retrospectively reviewed the medical records of 278 patients that were diagnosed with a midshaft clavicle fracture (male 190; female 88) that had (1) undergone ORIF of the clavicle with plates and (2) received a second operation for removal of hardware after solid union of the fracture between 2010 and 2017. Their mean age was 40.1 ± 15.1 years, and mean interval from fixation to plate removal was 12.5 ± 7.5 months. The patients were then divided into two groups based on the presence of refracture (n = 20) or without refracture (n = 258). We analyzed patient demographics, interval between fixation and implant removal, fracture classification (AO/OTA, Robinson), fixation device, whether wires or interfragmentary screws were used, clavicular length, and bone diameter at the fracture site.ResultsThe overall refracture rate was 7.2%, and the mean interval between plate removal and refracture was 23.9 days. A multivariate analysis showed that female (adjusted odds ratio [aOR] 4.74; 95% CI 1.6–14.1) and body mass index [BMI] (for every 1-unit decrease, aOR 1.25; 95% CI 1.06–1.48) were risk factors for refracture. In women, BMI was the only risk factor. The optimal BMI cutoff value was 22.73. In a female patient with a lower BMI, the refracture rate was 29.8%.ConclusionsThere are no significant radiographic parameters associated with refracture. Routine plate removal in a female patient with a low BMI after bony union of a midshaft clavicle fracture is not recommended because of a high refracture rate.

Plating and cortical bone grafting of clavicular nonunions: clinical outcome and its relation to clavicular length restoration

“…Refractures of healed clavicles following plate removal are well-known complications and may be related to conditions other than the status of bone healing, such as female sex and low body mass index. 31 Nevertheless, all of these patients had undergone multiple operations prior to the index surgical procedure. All refractures also occurred in the midshaft area known as the “vascular watershed line” of the clavicular bone.…”

“…The final follow-up examination included measurements of active and passive shoulder range of motion and abduction strength using a spring balance. The presence of scapular dyskinesis was recorded using the simplified dichotomous method described by the working group of Kibler et al 10 , 31 (ie, yes or no, in which yes indicates an abnormal dyskinesis pattern whereas no indicates normal scapular motion). 10 , 31 The clinical functional outcome was also assessed using the Constant score (CS).…”

“…The presence of scapular dyskinesis was recorded using the simplified dichotomous method described by the working group of Kibler et al 10 , 31 (ie, yes or no, in which yes indicates an abnormal dyskinesis pattern whereas no indicates normal scapular motion). 10 , 31 The clinical functional outcome was also assessed using the Constant score (CS). 3 Subjective patient-rated outcomes were determined with the questionnaires for the Simple Shoulder Test (SST) and Subjective Shoulder Value (SSV), 5 in addition to a 0-10 numeric rating scale for locally perceived pain level, on which 0 indicated no pain and 10 indicated maximal pain.…”

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

“…Regarding the refracture, there are several common risk factors: comminuted fracture pattern and bone defects [32,33], inadequate compression between fractures [32], microfracture occurred during removal of screws or wires [34]. Recently, Tsai et al [35] claimed that female and low BMI were another two risk factors associated with refracture post plate removal for midshaft clavicle fractures. In our study, the female patient suffering from refracture was a slim young woman with a very small bone diameter.…”

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

“…Since the frequency of ORIF increases with clavicle fracture, some studies have reported the issue of implant removal (IR) [11][12][13]. In some cases, IR is inevitable due to infection, nonunion, or implant breakage.…”