Symptomatic Implant Removal Following Dual Mini-Fragment Plating for Clavicular Shaft Fractures
Cory M Czajka1, Andrew Kay, Joshua L Gary
1*Department of Orthopaedic Surgery, University of Texas at Houston, Houston, TX; and †Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX.
Objectives:
To determine the proportion of patients requiring secondary surgery for symptomatic implant removal after open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures.
Design:
Retrospective observational study.
Setting:
Single university Level 1 trauma center.
Patients:
Eighty-one patients treated with open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures (OTA/AO 15-B1, B2, and B3) with minimum 12-month follow-up (median 477 days; range 371-1549 days).
Intervention:
Open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures.
Main Outcome Measurements:
Incidence of secondary surgery, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) scores.
Results:
Six of 81 patients (7.4%) underwent secondary surgery for implant removal for any reason. Of these, 3 (3.7%) underwent symptomatic implant (soft-tissue irritation) removal, 2 (2.5%) required implant removal in the setting of infection, and 1 patient (1.2%) required revision open reduction internal fixation for early implant failure. The mean QuickDASH score in this series was 8.44 (±6.94, range 0-77.27). The associated implant cost of the typical construct utilized in this series was $1511.38. The mean surgical time was 97 minutes (range 71-143 minutes).
Conclusions:
The utilization of a dual mini-fragment plating technique in the treatment of clavicular shaft fractures results in a low rates of secondary surgery for symptomatic implant removal (3.7%) and similar QuickDASH scores when compared with historical controls treated with 3.5-mm plates placed on the superior clavicle. Potential disadvantages in using this technique include a higher surgical implant cost and length of surgery.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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