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Published on: November 8, 2024
Refracture after implant removal of the clavicle: a retrospective cohort analysis
Ahmed Ellafi1, Eva Coenen1, Tobias Resch1
1Department of Trauma Surgery, TUM University Hospital Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Background:
Refracture after implant removal in clavicle fractures is a relevant but insufficiently studied complication. Reported refracture rates vary due to small cohorts and heterogeneous populations. This study aims to determine the incidence of refracture following elective implant removal after confirmed fracture union and to identify potential demographic, clinical, and fracture-related risk factors.
Methods:
A retrospective cohort of 575 adults who underwent implant removal after radiographically confirmed union between 2011 and 2024 was analyzed. Patients were assigned to a refracture (R) or non-refracture (NR) group. Demographics, fracture characteristics, treatment variables, and time intervals were analyzed.
Results:
Refractures occurred in 21/575 patients (3.7%). No significant differences were observed between the R and NR groups regarding age, BMI, ASA classification, or tobacco use. The interval between initial fixation and implant removal was shorter in the refracture group but not statistically significant (18.8 ± 8.7 vs. 21.2 ± 18.5 months; p = 0.55). Most refractures occurred at the original fracture site (n = 19; 90.5%) and were mostly midshaft fractures (n = 18; 85.7%). Only the AO 15.2C fracture type showed a significant association with refracture (R: 11.1% vs. NR: 1.9%; p = 0.005). In time-to-event analysis, AO 15.2C fractures were independently associated with refracture (HR 6.70, 95% CI 1.49-30.12; p = 0.013). Refracture-free survival was 97.4% at 1 year and 96.2% at 10 years. Implant removal was most frequently performed due to patient preference (R: 66.7% vs. NR: 50%).
Conclusion:
Refracture after clavicle implant removal is an uncommon yet clinically relevant complication. The overall refracture rate was 3.7% in the present study. Neither demographic variables nor implant retention time were significantly associated with refracture risk, whereas fracture morphology-specifically complex midshaft fractures (AO 15.2C)-was the only significant risk factor identified. Fracture morphology should therefore be a key consideration when deciding on elective implant removal. Further prospective research is needed to refine guidelines on optimal timing and patient selection.
