Complications associated with operative fixation of acute midshaft clavicle fractures

Asadollahi, Saeed, Hau, Raphael C., Page, Richard S., Richardson, Martin and Edwards, Elton R. 2016, Complications associated with operative fixation of acute midshaft clavicle fractures, Injury, vol. 47, no. 6, pp. 1248-1252, doi: 10.1016/j.injury.2016.02.005.

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Title Complications associated with operative fixation of acute midshaft clavicle fractures
Author(s) Asadollahi, Saeed
Hau, Raphael C.
Page, Richard S.ORCID iD for Page, Richard S.
Richardson, Martin
Edwards, Elton R.
Journal name Injury
Volume number 47
Issue number 6
Start page 1248
End page 1252
Total pages 5
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-06
ISSN 1879-0267
Keyword(s) Clavicle fracture
Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
Emergency Medicine
General & Internal Medicine
Summary The aim of this study was to review the complication rate and profile associated with surgical fixation of acute midshaft clavicle fracture in a large cohort of patients treated in a level I trauma centre.Patients and methods: We identified all patients who underwent surgical treatment of acute midshaft clavicle fracture between 2002 and 2010. The study group consisted of 138 fractures (134 patients). There were 107 males (78%) and 31 females (22%) and median age of 35 years (IQR 24-45). The most common mechanism of injury was a road traffic accident (78%). Sixty percent (n = 83) had an injury severity score of ≥ 15 indicating major trauma. The most common fracture type (75%) was simple or wedge comminuted (2B1) according to the Edinburgh classification. The median interval between the injury and operation was 3 days (IQR 1-6). Plate fixation was performed in 110 fractures (80%) and intramedullary fixation was performed in 28 fractures (20%). There were 85 males and 25 females in the plate fixation group with median age of 35 years (IQR: 25-45) There were 22 males and 6 females in intramedullary fixation group with median age of 31 years (IQR 24-42 years). Statistical analysis was performed using Independent sample t-test, Mann-Whitney test, and Chi-square test. Significant P-value was < 0.05.Results: The overall incidence of complication was 14.5% (n = 20). The overall nonunion rate 6%. Post operative wound infection occurred in 3.6% of cases. The incidence of complication associated with plate fixation was 10% (11 of 110 cases) compared to 32% associated with intramedullary fixation (9 of 28 cases) (P = 0.003). Thirty five percent of complications were related to inadequate surgical technique and potentially avoidable. Symptomatic hardware requiring removal occurred in 23% (n = 31) of patients. Symptomatic metalware was more frequent after plate fixation compared to intramedullary fixation (26% vs 7%, P = 0.03).Conclusions: Intramedullary fixation of midshaft clavicle fracture is associated with higher incidence of complications. Plate fixation is associated with a higher rate of symptomatic metalware requiring removal compared to intramedullary fixation. Approximately one in three complications may be avoided by attention to adequate surgical technique.
Language eng
DOI 10.1016/j.injury.2016.02.005
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Elsevier
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Document type: Journal Article
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School of Medicine
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