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Published in: Journal of Orthopaedic Surgery and Research 1/2014

Open Access 01-12-2014 | Research article

Does plate type influence the clinical outcomes and implant removal in midclavicular fractures fixed with 2.7-mm anteroinferior plates? A retrospective cohort study

Authors: Alex K Gilde, Clifford B Jones, Debra L Sietsema, Martin F Hoffmann

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2014

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Abstract

Background

The purpose of this study was to evaluate surgical healing rates, implant failure, implant removal, and the need for surgical revision with regards to plate type in midshaft clavicle fractures fixed with 2.7-mm anteroinferior plates utilizing modern plating techniques.

Methods

This retrospective exploratory cohort review took place at a level I teaching trauma center and a single large private practice office. A total of 155 skeletally mature individuals with 156 midshaft clavicle fractures between March 2002 and March 2012 were included in the final results. Fractures were identified by mechanism of injury and classified based on OTA/AO criteria. All fractures were fixed with 2.7-mm anteroinferior plates. Primary outcome measurements included implant failure, malunion, nonunion, and implant removal. Secondary outcome measurements included pain with the visual analog scale and range of motion. Statistically significant testing was set at 0.05, and testing was performed using chi-square, Fisher’s exact, Mann–Whitney U, and Kruskall-Wallis.

Results

Implant failure occurred more often in reconstruction plates as compared to dynamic compression plates (p = 0.029). Malunions and nonunions occurred more often in fractures fixed with reconstruction plates as compared to dynamic compression plates, but it was not statistically significant. Implant removal attributed to irritation or implant prominence was observed in 14 patients. Statistically significant levels of pain were seen in patients requiring implant removal (p = 0.001) but were not associated with the plate type.

Conclusions

Anteroinferior clavicular fracture fixation with 2.7-mm dynamic compression plates results in excellent healing rates with low removal rates in accordance with the published literature. Given higher rates of failure, 2.7-mm reconstruction plates should be discouraged in comparison to stiffer and more reliable 2.7-mm dynamic compression plates.
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Literature
1.
go back to reference Lazarides S, Zafiropoulos G: Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006, 15: 191-194. 10.1016/j.jse.2005.08.007.CrossRefPubMed Lazarides S, Zafiropoulos G: Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006, 15: 191-194. 10.1016/j.jse.2005.08.007.CrossRefPubMed
2.
go back to reference Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD: Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005, 19: 504-507. 10.1097/01.bot.0000172287.44278.ef.CrossRefPubMed Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD: Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005, 19: 504-507. 10.1097/01.bot.0000172287.44278.ef.CrossRefPubMed
3.
go back to reference McKee MD, Kreder HJ, Mandel S, McCormack R, Reindl R, Pugh DMW, Sanders D, Buckley R: Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures - a multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007, 89A: 1-10. McKee MD, Kreder HJ, Mandel S, McCormack R, Reindl R, Pugh DMW, Sanders D, Buckley R: Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures - a multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007, 89A: 1-10.
4.
go back to reference Kulshrestha V, Roy T, Audige L: Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma. 2011, 25: 31-38. 10.1097/BOT.0b013e3181d8290e.CrossRefPubMed Kulshrestha V, Roy T, Audige L: Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma. 2011, 25: 31-38. 10.1097/BOT.0b013e3181d8290e.CrossRefPubMed
5.
go back to reference Singh R, Rambani R, Kanakaris N, Giannoudis PV: A 2-year experience, management and outcome of 200 clavicle fractures. Injury. 2012, 43: 159-163. 10.1016/j.injury.2011.04.008.CrossRefPubMed Singh R, Rambani R, Kanakaris N, Giannoudis PV: A 2-year experience, management and outcome of 200 clavicle fractures. Injury. 2012, 43: 159-163. 10.1016/j.injury.2011.04.008.CrossRefPubMed
6.
go back to reference Wijdicks FJG, Van der Meijden OAJ, Millett PJ, Verleisdonk E, Houwert RM: Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012, 132: 617-625. 10.1007/s00402-011-1456-5.PubMedCentralCrossRefPubMed Wijdicks FJG, Van der Meijden OAJ, Millett PJ, Verleisdonk E, Houwert RM: Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012, 132: 617-625. 10.1007/s00402-011-1456-5.PubMedCentralCrossRefPubMed
7.
go back to reference Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R: Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma. 2006, 20: 680-686. 10.1097/01.bot.0000249434.57571.29.CrossRefPubMed Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R: Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma. 2006, 20: 680-686. 10.1097/01.bot.0000249434.57571.29.CrossRefPubMed
8.
go back to reference Kloen P, Werner CML, Stufkens SAS, Helfet DL: Anteroinferior plating of midshaft clavicle nonunions and fractures. Oper Orthop Traumatol. 2009, 21: 170-179. 10.1007/s00064-009-1705-8.CrossRefPubMed Kloen P, Werner CML, Stufkens SAS, Helfet DL: Anteroinferior plating of midshaft clavicle nonunions and fractures. Oper Orthop Traumatol. 2009, 21: 170-179. 10.1007/s00064-009-1705-8.CrossRefPubMed
9.
go back to reference Galdi B, Yoon RS, Choung EW, Reilly MC, Sirkin M, Smith WR, Liporace FA: Anteroinferior 2.7-mm versus 3.5-mm plating for AO/OTA type B clavicle fractures: a comparative cohort clinical outcomes study. J Orthop Trauma. 2013, 27: 121-125. 10.1097/BOT.0b013e3182693f32.CrossRefPubMed Galdi B, Yoon RS, Choung EW, Reilly MC, Sirkin M, Smith WR, Liporace FA: Anteroinferior 2.7-mm versus 3.5-mm plating for AO/OTA type B clavicle fractures: a comparative cohort clinical outcomes study. J Orthop Trauma. 2013, 27: 121-125. 10.1097/BOT.0b013e3182693f32.CrossRefPubMed
10.
go back to reference Taylor PRP, Day RE, Nicholls RL, Rasmussen J, Yates PJ, Stoffel KK: The comminuted midshaft clavicle fracture: a biomechanical evaluation of plating methods. Clin Biomech. 2011, 26: 491-496. 10.1016/j.clinbiomech.2010.12.007.CrossRef Taylor PRP, Day RE, Nicholls RL, Rasmussen J, Yates PJ, Stoffel KK: The comminuted midshaft clavicle fracture: a biomechanical evaluation of plating methods. Clin Biomech. 2011, 26: 491-496. 10.1016/j.clinbiomech.2010.12.007.CrossRef
11.
go back to reference Favre P, Kloen P, Helfet DL, Werner CML: Superior versus anteroinferior plating of the clavicle: a finite element study. J Orthop Trauma. 2011, 25: 661-665. 10.1097/BOT.0b013e3182143e06.CrossRefPubMed Favre P, Kloen P, Helfet DL, Werner CML: Superior versus anteroinferior plating of the clavicle: a finite element study. J Orthop Trauma. 2011, 25: 661-665. 10.1097/BOT.0b013e3182143e06.CrossRefPubMed
12.
go back to reference Jones CB, Sietsema DL, Ringler JR, Endres TJ, Hoffmann MF: Results of anterior-inferior 2.7-mm dynamic compression plate fixation of midshaft clavicular fractures. J Orthop Trauma. 2013, 27: 126-129. 10.1097/BOT.0b013e318254883a.CrossRefPubMed Jones CB, Sietsema DL, Ringler JR, Endres TJ, Hoffmann MF: Results of anterior-inferior 2.7-mm dynamic compression plate fixation of midshaft clavicular fractures. J Orthop Trauma. 2013, 27: 126-129. 10.1097/BOT.0b013e318254883a.CrossRefPubMed
13.
go back to reference Eden L, Doht S, Frey SP, Ziegler D, Stoyhe J, Fehske K, Blunk T, Meffert RH: Biomechanical comparison of the locking compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation. Int Orthop. 2012, 36: 2537-2543. 10.1007/s00264-012-1671-x.PubMedCentralCrossRefPubMed Eden L, Doht S, Frey SP, Ziegler D, Stoyhe J, Fehske K, Blunk T, Meffert RH: Biomechanical comparison of the locking compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation. Int Orthop. 2012, 36: 2537-2543. 10.1007/s00264-012-1671-x.PubMedCentralCrossRefPubMed
14.
go back to reference Drosdowech DS, Manwell SEE, Ferreira LM, Goel DP, Faber KJ, Johnson JA: Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma. 2011, 25: 39-43. 10.1097/BOT.0b013e3181d8893a.CrossRefPubMed Drosdowech DS, Manwell SEE, Ferreira LM, Goel DP, Faber KJ, Johnson JA: Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma. 2011, 25: 39-43. 10.1097/BOT.0b013e3181d8893a.CrossRefPubMed
15.
go back to reference Potter JM, Jones C, Wild LM, Schemitsch EH, McKee MD: 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. 2007, 16: 514-518. 10.1016/j.jse.2007.01.001.CrossRefPubMed Potter JM, Jones C, Wild LM, Schemitsch EH, McKee MD: 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. 2007, 16: 514-518. 10.1016/j.jse.2007.01.001.CrossRefPubMed
16.
go back to reference Kim W, McKee MD: Management of acute clavicle fractures. Orthop Clin North Am. 2008, 39: 491-505. 10.1016/j.ocl.2008.05.006.CrossRefPubMed Kim W, McKee MD: Management of acute clavicle fractures. Orthop Clin North Am. 2008, 39: 491-505. 10.1016/j.ocl.2008.05.006.CrossRefPubMed
17.
go back to reference Altamimi SA: Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone and Joint Surg Am. 2008, 90 (2): 1-8. Altamimi SA: Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone and Joint Surg Am. 2008, 90 (2): 1-8.
18.
go back to reference Scott J, Huskisson EC: Graphic representation of pain. Pain. 1976, 2: 175-184. 10.1016/0304-3959(76)90113-5.CrossRefPubMed Scott J, Huskisson EC: Graphic representation of pain. Pain. 1976, 2: 175-184. 10.1016/0304-3959(76)90113-5.CrossRefPubMed
19.
go back to reference Sharr JRP, Mohammed KD: Optimizing the radiographic technique in clavicular fractures. J Shoulder Elbow Surg. 2003, 12: 170-172. 10.1067/mse.2003.25.CrossRefPubMed Sharr JRP, Mohammed KD: Optimizing the radiographic technique in clavicular fractures. J Shoulder Elbow Surg. 2003, 12: 170-172. 10.1067/mse.2003.25.CrossRefPubMed
20.
go back to reference Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L: Fracture and dislocation classification compendium-2007 - Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007, 21: S1-S133. 10.1097/00005131-200711101-00001.CrossRefPubMed Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L: Fracture and dislocation classification compendium-2007 - Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007, 21: S1-S133. 10.1097/00005131-200711101-00001.CrossRefPubMed
21.
go back to reference Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS: Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures - a randomized, controlled, clinical trial. J Orthop Trauma. 2009, 23: 106-112. 10.1097/BOT.0b013e318190cf88.CrossRefPubMed Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS: Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures - a randomized, controlled, clinical trial. J Orthop Trauma. 2009, 23: 106-112. 10.1097/BOT.0b013e318190cf88.CrossRefPubMed
22.
go back to reference Smekal V, Oberladstaetter J, Struve P, Krappinger D: Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg. 2009, 129: 807-815. 10.1007/s00402-008-0775-7.CrossRefPubMed Smekal V, Oberladstaetter J, Struve P, Krappinger D: Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg. 2009, 129: 807-815. 10.1007/s00402-008-0775-7.CrossRefPubMed
23.
go back to reference Neer CS: Nonunion of the clavicle. JAMA. 1960, 172: 1006-1011. 10.1001/jama.1960.03020100014003.CrossRef Neer CS: Nonunion of the clavicle. JAMA. 1960, 172: 1006-1011. 10.1001/jama.1960.03020100014003.CrossRef
24.
go back to reference Rowe CR: An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968, 58: 29-42. 10.1097/00003086-196805000-00006.CrossRefPubMed Rowe CR: An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968, 58: 29-42. 10.1097/00003086-196805000-00006.CrossRefPubMed
25.
go back to reference 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, 94A: 675-684. 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, 94A: 675-684.
26.
go back to reference Riddiford-Harland DL, Steele JR, Baur LA: Upper and lower limb functionality: are these compromised in obese children?. Int J Pediatr Obes. 2006, 1: 42-49. 10.1080/17477160600586606.CrossRefPubMed Riddiford-Harland DL, Steele JR, Baur LA: Upper and lower limb functionality: are these compromised in obese children?. Int J Pediatr Obes. 2006, 1: 42-49. 10.1080/17477160600586606.CrossRefPubMed
27.
go back to reference Robinson CM: Fractures of the clavicle in the adult - epidemiology and classification. J Bone Joint Surg-British. 1998, 80B: 476-484. 10.1302/0301-620X.80B3.8079.CrossRef Robinson CM: Fractures of the clavicle in the adult - epidemiology and classification. J Bone Joint Surg-British. 1998, 80B: 476-484. 10.1302/0301-620X.80B3.8079.CrossRef
Metadata
Title
Does plate type influence the clinical outcomes and implant removal in midclavicular fractures fixed with 2.7-mm anteroinferior plates? A retrospective cohort study
Authors
Alex K Gilde
Clifford B Jones
Debra L Sietsema
Martin F Hoffmann
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2014
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-014-0055-x

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