Prognostic factors and outcomes of secondary surgery after plate fixation for midshaft clavicle fracture: Comparison of traditional DCP and pre-contoured locking plate

• Published in: Injury 2020-10, Vol.51 (10), p.2241-2244
• Main Authors: Hsiao, Yung-Chuan, Lin, Tung-Yi, Wang, Ying-Chih, Chang, Chia-Wei, Tang, Hao-Che, Chen, Chien-Hao, Su, Chun- Yi
• Format: Article
• Language: English
• Subjects: Locking plate fixation; Midshaft clavicle fractures; Precontoured plate; Prognostic factors; Reoperation
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.06.030

•This review summarizes the current evidence for reoperation after plate fixation for midshaft clavicle fracture which is a high incidence of complication.•We find postoperative superficial wound infection, prominent implant as the risk factors for reoperation.•Aging, pre-contoured plate usage, and higher BMI play protective factors that decrease risk of reoperation after primary plate surgery.•Compared with DCP, pre-contoured locking plate tends to bring better prognosis and effectively decreases reoperation rate. This study aimed to evaluate the prognostic factors of reoperation after plate fixation for midshaft clavicle fracture and compare outcomes of dynamic compression plates (DCP) and pre-contoured locking plates. Retrospective comparative study. Level I trauma center. We recruited 274 consecutive patients who underwent plate fixation for midshaft clavicle fracture from 2007 to 2017 and completed at least 1 year of follow-up. 235 patients underwent surgery with DCP, while 39 patients were treated with locking plate. We reviewed the possible variables of secondary surgeries, and documented complications from the medical records. Patients with a DCP or locking plate were further divided for outcome comparisons. 150 (54.7%) patients underwent reoperation after the initial surgery, and plate removal represented the major etiology. On multivariate analysis, superficial wound infection and prominent implant were identified as significant risk factors for reoperation, while aging, locking plate usage, and higher body mass index (BMI) were protective factors (all P < 0.05). The locking plate featured a significantly decreased implant removal rate (7.7% vs. 60.9%, P < 0.05). Patients with risk factors for superficial wound infection or a prominent implant tended to require a secondary operation after surgery for midshaft clavicle fracture, while aging, pre-contoured locking plate usage, and higher BMI decreased the risk. Compared with DCP, patients with locking plates tended to have better prognosis and significantly lower implant removal rates. Prognostic III.