Sat., 10/6/12 Upper Extremity Injuries, PAPER #87, 10:56 am OTA-2012
Prognostic Factors for Reoperation Following Plate Fixation of Fractures of the Midshaft Clavicle
Laura A. Schemitsch; Emil H. Schemitsch, MD; Paul R. Kuzyk, MD; Michael D. McKee, MD; Milena R. Vicente, RN, CCRP;
St. Michael’s Hospital, Toronto, Ontario, Canada
Purpose: Plate fixation of midshaft fractures of the clavicle has become an accepted treatment technique for completely displaced injuries. However, little information is available regarding reoperation, a frequent concern. We conducted a retrospective review to determine which prognostic factors were associated with reoperation following plate fixation of completely displaced midshaft fractures.
Methods: We identified 235 consecutive patients who underwent plate fixation for a midshaft clavicle fracture at a single university-affiliated Level I trauma center between July 1, 2000 and July 1, 2009. We examined for 21 possible prognostic variables using multivariate logistic regression analysis and documented reoperation rates.
Results: 235 were identified. 82 patients had less than 2-year follow-up and were excluded from the study: none of these patients had had any further surgery at the time of last follow-up. 153 patients were contacted and assessed (65% of the total cohort). 58 of these patients had had reoperations (38%), with 8 of these individuals requiring multiple procedures (5%). The majority of individuals had reoperation for plate removal (50 of 153, 33%), while the others were for nonunion, hardware failure, refracture, or infection (8 of 153, 5%). Plate removal was associated with the use of straight, noncontoured plates, and height <175 cm (P <0.01). Risk factors for multiple reoperations (ie, for infection, nonunion, fixation failure, etc) included substance abuse (illicit drugs or alcohol), diabetes, and age >55 years (P <0.01). This information can be used prognostically: for example, use of a contoured plate in a person >175 cm tall results in a plate removal rate of only 9%. Conversely, substance abuse increases the risk of requiring multiple reoperations from 3% to 25%.
Conclusion: We have presented the largest series to date that defines the rate of, and risk factors associated with, reoperation following plate fixation of displaced midshaft fractures of the clavicle. Our assessment of 153 patients provides some useful clinical information for treatment and prognosis. Plate fixation of the clavicle is a safe, reliable operation with a low major complication rate (5%). The rate of plate removal is significant (33%), and associated with the use of straight plates; precontoured plates decrease this rate. Shorter (smaller) patients had an increased rate of plate removal and can be counseled accordingly. Patients with substance abuse issues, diabetes, or age >55 years had a significantly higher need for multiple reoperations due to serious complications such as fixation failure or infection. Given the relatively narrow risk-benefit profile of clavicle fracture fixation, extreme caution should be used in recommending primary operative repair in these individuals.
Alphabetical Disclosure Listing (808K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.