Risk factors for hardware removal following operative treatment of middle- and distal-third clavicular fractures
Brian P Davis1, Theodore B Shybut1, Michelle M Coleman2
1Baylor College of Medicine, Houston, TX, USA.
Insights
Hardware removal (HWR) after clavicular fracture fixation occurred in 12.6% of patients. Distal fractures and high-energy injuries increased HWR risk, with symptomatic hardware being the main reason for removal.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Biomedical engineering
Background:
- Hardware removal (HWR) after clavicular fracture fixation incidence varies, with risk factors not fully understood.
- Plate fixation is a common treatment for middle- and distal-third clavicular fractures.
- Understanding HWR incidence and predictors is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the incidence of HWR after plate fixation of clavicular fractures.
- To identify risk factors associated with HWR in clavicular fracture repair.
- To determine the primary indications for HWR in these patients.
Main Methods:
- Multi-hospital retrospective study of 103 skeletally mature patients.
- Analysis of data including demographics, injury mechanism, operative records, and HWR outcomes.
- Follow-up period from November 2008 to November 2018.
Main Results:
- Overall HWR incidence was 12.6% (13 out of 103 patients).
- Distal clavicular fractures had a significantly higher HWR rate (50%) compared to middle-third fractures (4.9%).
- High-energy injury mechanism (P = .0025) and symptomatic hardware (69.2%) were significant factors associated with HWR.
Conclusions:
- Clavicular fracture HWR incidence is 12.6%, aligning with the hypothesis of <20%.
- Distal fracture location and high-energy injury mechanisms are significant risk factors for HWR.
- Symptomatic hardware remains the primary indication for hardware removal after clavicular fracture fixation.
Background:
The incidence of hardware removal (HWR) after operative fixation of clavicular fractures varies widely. Risk factors related to HWR remain incompletely understood. The aim of this study was to evaluate the incidence of and risk factors for HWR after plate fixation of middle- and distal-third clavicular fractures. We hypothesized that (1) the total HWR incidence would be <20%, (2) the HWR incidence of operatively treated distal- and middle-third clavicular fractures would not be statistically different, and (3) symptomatic implants would be the most common HWR indication.
Methods:
We performed a multi-hospital retrospective study of skeletally mature patients who underwent plate fixation of middle- and distal-third clavicular fractures from November 2008 to November 2018. Data included patient demographic characteristics, mechanism of injury, operative records, hardware-related symptoms, subsequent HWR, and complications.
Results:
A total of 103 patients (aged 16-75 years, 76.7% male patients) were included. Of the patients, 87 (84.5%) underwent plate fixation for midshaft clavicular fractures and 16 (15.5%) underwent plate fixation for distal-third clavicular fractures. HWR was performed in 13 patients (12.6%). A significantly higher percentage of HWR procedures were performed for distal clavicular fractures (50%) than for middle-third clavicular fractures (4.9%, P < .0001). An initial high-energy mechanism of injury was associated with HWR (P = .0025). The most common indication for HWR was symptomatic hardware (69.2%). The overall complication rate was 14.5%.
Conclusion:
The overall incidence of clavicular HWR was 12.6%. A distal fracture location was associated with a significantly higher incidence of HWR. An initial high-energy mechanism of injury was a significant risk factor for HWR. The primary indication for HWR was symptomatic hardware.
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