Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Refracture after locking compression plate removal in displaced midshaft clavicle fractures after bony union: a retrospective study

  • Park, Ho-Youn (Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Seok-Jung (Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sur, Yoo-Joon (Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung, Jae-Woong (Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kong, Chae-Gwan (Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2021.01.30
  • Accepted : 2021.03.27
  • Published : 2021.06.01
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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.

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References

  1. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am 2009;91:447-60. https://doi.org/10.2106/JBJS.H.00034
  2. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994;(300):127-32.
  3. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures: a prospective study during a two-year period in Uppsala, Sweden. Injury 2000;31:353-8. https://doi.org/10.1016/S0020-1383(99)00312-5
  4. NEER CS 2nd. Nonunion of the clavicle. J Am Med Assoc 1960;172:1006-11. https://doi.org/10.1001/jama.1960.03020100014003
  5. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
  6. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-10. https://doi.org/10.2106/00004623-200701000-00001
  7. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132:617-25. https://doi.org/10.1007/s00402-011-1456-5
  8. van der Meijden OA, Houwert RM, Hulsmans M, et al. Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial. J Bone Joint Surg Am 2015;97:613-9. https://doi.org/10.2106/JBJS.N.00449
  9. Russo R, Visconti V, Lorini S, Lombardi LV. Displaced comminuted midshaft clavicle fractures: use of Mennen plate fixation system. J Trauma 2007;63:951-4. https://doi.org/10.1097/TA.0b013e31814549e7
  10. VanBeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Precontoured plating of clavicle fractures: decreased hardware-related complications. Clin Orthop Relat Res 2011;469:3337-43. https://doi.org/10.1007/s11999-011-1868-0
  11. Leroux T, Wasserstein D, Henry P, et al. Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study in Ontario, Canada. J Bone Joint Surg Am 2014;96:1119-25. https://doi.org/10.2106/JBJS.M.00607
  12. Hulsmans MH, van Heijl M, Houwert RM, et al. High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 2017;475:532-9. https://doi.org/10.1007/s11999-016-5113-8
  13. Tsai SW, Ma HH, Hsu FW, et al. Risk factors for refracture after plate removal for midshaft clavicle fracture after bone union. J Orthop Surg Res 2019;14:457. https://doi.org/10.1186/s13018-019-1516-z
  14. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012;94:675-84. https://doi.org/10.2106/JBJS.J.01364
  15. Andrade-Silva FB, Kojima KE, Joeris A, Santos Silva J, Mattar R Jr. Single, superiorly placed reconstruction plate compared with flexible intramedullary nailing for midshaft clavicular fractures: a prospective, randomized controlled trial. J Bone Joint Surg Am 2015;97:620-6. https://doi.org/10.2106/JBJS.N.00497
  16. Wurm M, Beirer M, Zyskowski M, et al. Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial. Arch Orthop Trauma Surg 2020 Nov 1 [Epub]. https://doi.org/10.1007/s00402-020-03669-z.
  17. Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 1997;43:778-83. https://doi.org/10.1097/00005373-199711000-00008
  18. Yao CK, Lin KC, Tarng YW, Chang WN, Renn JH. Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture. Arch Orthop Trauma Surg 2014;134: 1691-7. https://doi.org/10.1007/s00402-014-2079-4