Risk factors for postoperative complications of displaced clavicular midshaft fractures.

BACKGROUND: This study evaluated the risk factors of the complications following operative treatment of an acute displaced clavicular midshaft fracture using a reconstruction plate.
METHODS: One hundred twenty-five patients with an acute displaced clavicular midshaft fracture underwent open reduction and plate fixation using a reconstruction plate. Cerclage wires or interfragmentary screws were used for additional comminuted fragment fixation. Clinical outcomes and radiologic evaluation were assessed. Risk factors for postoperative complications requiring reoperation were analyzed by univariate analysis.
RESULTS: Bony union was achieved in 110 patients without any complications within 10.6 weeks postoperatively. Fifteen patients (12%) had a complication requiring reoperation. Implant-related complications occurred in 10 patients (plate breakage in 6 and plate loosening in 4). Deep infection and intractable adhesive capsulitis occurred in one and two patients, respectively. Refracture of the same clavicle after plate removal occurred in two patients. All patients with plate breakage demonstrated nonunion at the time of second operation. Unlike plate breakage, plate loosening was found to be associated with technical errors. Preoperative fracture pattern (p = 0.012) and usage of cerclage wires for additional fragment fixation were found to be significantly related to implant failure (p = 0.009).
CONCLUSIONS: Open reduction and internal fixation using a reconstruction plate for acute displaced clavicular midshaft fractures demonstrated satisfactory clinical outcomes and favorable bony union rates. However, hardware-related complications because of fracture pattern, nonunion, and inadequate surgical techniques require detailed consideration. Furthermore, when additional fixation is needed for comminuted fracture fragments, interfragmentary screw fixation is recommended before cerclage wiring.