Abstract
An important consideration when counselling patients with midshaft clavicle fractures is whether operative treatment of non-union, if it develops after non-operative treatment, is associated with higher complication rate than acute fracture fixation. The aim of this study is to compare complications and re-operations after open reduction and plate fixation for acute midshaft clavicle fractures versus non-unions. The study was retrospective. There were 90 patients in the acute fixation group and 20 patients in the non-union group. The mean follow-up was 8 and 15 months, respectively, Logistic regression analysis was used to assess whether ‘non-union surgery’ was a predictor of complications and re-operations. Of 90 patients, 23 had complications in acute fixation group. Of 20, 7 developed 8 complications in the non-union group (p = 0.4). Of 90, 12 required re-operations in the acute fixation group compared to 5/20 requiring 7 re-operations in the non-union group (p = 0.19). When any complication or re-operation was considered, ‘non-union surgery’ was not significant predictor for complications (p = 0.78) or re-operations (p = 0.99). The complication and re-operation rates were not higher after non-union surgery compared to acute fracture fixation and were mostly related to persistent delayed or non-union, rather than operative complications. When counselling patients about treatment of midshaft clavicle fractures, a ‘higher complication rate after surgery for non-union, should it happen’ should not be an argument against non-operative treatment.
Similar content being viewed by others
References
Canadian Orthopaedic Trauma Society (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89(1):1–10
Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, Foster CJ, Clark K, Brooksbank AJ, Arthur A, Crowther MA, Packham I, Chesser TJ (2013) Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am 95(17):1576–1584
McKee RC, Whelan DB, Schemitsch EH (2012) Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 94(8):675–684
McKnight B, Heckmann N, Hill JR, Pannell WC, Mostofi A, Omid R, Hatch GF (2016) Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures. J Shoulder Elbow Surg 25(9):1412–1417
Potter JM, Jones C, Wild LM, Schemitsch EH, McKee MD (2007) Does delay matter? The restoration of objectively measured shoulder strength and patient-oriented outcome after immediate fixation versus delayed reconstruction of displaced midshaft fractures of the clavicle. J Shoulder Elbow Surg 16(5):514–518
Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80(3):476–484
Persico F, Lorenz E, Seligson D (2014) Complications of operative treatment of clavicle fractures in a Level I Trauma Center. Eur J Orthop Surg Traumatol 24(6):839–844
Asadollahi S, Hau RC, Page RS, Richardson M, Edwards ER (2016) Complications associated with operative fixation of acute midshaft clavicle fractures. Injury 47(6):1248–1252
Fridberg M, Ban I, Issa Z, Krasheninnikoff M, Troelsen A (2013) Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases. Int Orthop 37(4):689–692
Coupe BD, Wimhurst JA, Indar R, Calder DA, Patel AD (2005) A new approach for plate fixation of midshaft clavicular fractures. Injury 36(10):1166–1171
Der Tavitian J, Davison JN, Dias JJ (2002) Clavicular fracture non-union surgical outcome and complications. Injury 33:135–143
Ebraheim NA, Mekhail AO, Darwich M (1997) Open reduction and internal fixation with bone grafting of clavicular nonunion. J Trauma 42:701–704
Gheorghiu D, Sinopidis C, Brown D (2013) Treatment of acute clavicle fractures with an anatomical congruent clavicle plate. Glob J Surg 1(2):8–10
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Seif Sawalha and Inigo Guisasola declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Sawalha, S., Guisasola, I. Complications associated with plate fixation of acute midshaft clavicle fractures versus non-unions. Eur J Orthop Surg Traumatol 28, 1059–1064 (2018). https://doi.org/10.1007/s00590-018-2174-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-018-2174-2