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Title: Complications associated with operative fixation of acute midshaft clavicle fractures.
Epworth Authors: Richardson, Martin
Other Authors: Asadollahi, Saeed
Hau, Raphael
Page, Richard
Edwards, Elton
Keywords: Complication Rate
Complication Profile
Fractures, Bone
Bone Fractures
Fractures, Malunited
Fracture Fixation, Intramedullary
Intramedullary Nailing
Surgical Fixation
Wound Infection
Surgical Technique
Postoperative Complications
Edinburgh Classification
Sample T Test
Mann Whitney Test
Chi Square Test
Department of Surgery, Epworth Hospital, Melbourne, Victoria, Australia.
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Feb-2016
Publisher: Elsevier
Citation: Injury. 2016 Feb 17. pii: S0020-1383(16)00074-7
Abstract: INTRODUCTION: The aim of this study was to review the complication rate and profile associated with surgical fixation of acute midshaft clavicle fracture in a large cohort of patients treated in a level I trauma centre. PATIENTS AND METHODS: We identified all patients who underwent surgical treatment of acute midshaft clavicle fracture between 2002 and 2010. The study group consisted of 138 fractures (134 patients) and included 107 men (78%) and 31 women (22%); the median age of 35 years (interquartile range (IQR) 24-45). The most common mechanism of injury was a road traffic accident (78%). Sixty percent (n=83) had an injury severity score of ≥15 indicating major trauma. The most common fracture type (75%) was simple or wedge comminuted (2B1) according to the Edinburgh classification. The median interval between the injury and operation was 3 days (IQR 1-6). Plate fixation was performed in 110 fractures (80%) and intramedullary fixation was performed in 28 fractures (20%). There were 85 men and 25 women in the plate fixation group with median age of 35 years (IQR 25-45) There were 22 men and six women in the intramedullary fixation group with median age of 31 years (IQR 24-42 years). Statistical analysis was performed using independent sample t test, Mann Whitney test, and Chi square test. Significant P-value was <0.05. RESULTS: The overall incidence of complication was 14.5% (n=20). The overall nonunion rate was 6%. Postoperative wound infection occurred in 3.6% of cases. The incidence of complication associated with plate fixation was 10% (11 of 110 cases) compared to 32% associated with intramedullary fixation (nine of 28 cases; P=0.003). Thirty-five percent of complications were related to inadequate surgical technique and were potentially avoidable. Symptomatic hardware requiring removal occurred in 23% (n=31) of patients. Symptomatic metalware was more frequent after plate fixation compared to intramedullary fixation (26% vs 7%, P=0.03). CONCLUSIONS: Intramedullary fixation of midshaft clavicle fracture is associated with a higher incidence of complications. Plate fixation is associated with a higher rate of symptomatic metalware requiring removal compared to intramedullary fixation. Approximately one in three complications may be avoided by attention to adequate surgical technique.
DOI: 10.1016/j.injury.2016.02.005
PubMed URL:
ISSN: 0020-1383
Journal Title: Injury
Type: Journal Article
Affiliated Organisations: Nepean Hospital, Sydney, New South Wales, Australia.
Northern Hospital, Melbourne, Victoria, Australia.
University Hospital Geelong and School of Medicine, Deakin University, Geelong, Victoria, Australia.
Department of Orthopaedics, The Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Musculoskeletal

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