Unplanned Operations and Adverse Events after Surgery for Diaphyseal Fracture of the Clavicle

Document Type : RESEARCH PAPER

Authors

1 Massachusetts General Hospital, Hand Surgery, Boston, Massachusetts, USA

2 The University of Texas at Austin, Austin, TX

Abstract

Background: We used a database of patients treated at three hospitals to study the primary null hypothesis that there
are no factors associated with unplanned reoperations or adverse events after surgical repair for diaphyseal clavicle
fracture. Additionally we addressed the following secondary study questions: 1. What is the prevalence of unplanned
reoperations or adverse events after surgical repair for diaphyseal clavicle fracture? 2. Is early implant loosening or
breakage after surgical repair for diaphyseal clavicle fracture related to fixation type? 3. Is the type of fixation associated
with the prevalence of brachial plexus palsy after surgical repair of a diaphyseal clavicle fracture?
Methods: We retrospectively analyzed 249 adult patients who had surgery for a diaphyseal clavicle fracture to
determine factors associated with unplanned reoperations or adverse events. Thirty-two patients (13%) had at least one
unplanned reoperation or adverse event. Four of 249 patients (1.6%) developed early implant loosening or breakage.
Patients that had local implant irritation, planned implant removal, or sensory symptoms thought to be due to nerve
irritation were not included in the reported unplanned reoperations or adverse event rate.
Results: Only female sex was associated with unplanned reoperations or adverse events after surgery for diaphyseal
clavicle fracture. No other patient, technical, or injury related factors tested in this study were associated with unplanned
reoperations or adverse events.
Conclusion: Patients that have surgery for diaphyseal clavicle fracture have an approximately 13% risk of an unplanned
second surgery or an adverse event. Women can be counseled that they are three times as likely as men to have an
unplanned reoperations or adverse event.
Level of evidence: III

Keywords

Main Subjects

References

1. Bostman O, Manninen M, Pihlajamaki H. Complications
of plate fixation in fresh displaced midclavicular
fractures. J Trauma. 1997; 43(5):778-83.
2. d’Heurle A, Le T, Grawe B, Casstevens EC, Edgington J,
Archdeacon MT, et al. Perioperative risks associated
with the operative treatment of clavicle fractures.
Injury. 2013; 44(11):1579-81.
3. Hosalkar HS, Parikh G, Bittersohl B. Surgical fixation
of displaced clavicle fracture in adolescents: a review
of literature. Orthop Rev. 2013; 5(3):e29.
4. McKee MD, Pedersen EM, Jones C, Stephen DJ,
Kreder HJ, Schemitsch EH, et al. Deficits following
nonoperative treatment of displaced midshaft
clavicular fractures. J Bone Joint Surg Am. 2006;
88(1):35-40.
5. McKee RC, Whelan DB, Schemitsch EH, McKee MD.
Operative versus nonoperative care of displaced
midshaft clavicular fractures: a meta-analysis of
randomized clinical trials. J Bone Joint Surg Am.
2012; 94(8):675-84.
6. Ristevski B, Hall JA, Pearce D, Potter J, Farrugia
M, McKee MD. The radiographic quantification of
scapular malalignment after malunion of displaced
clavicular shaft fractures. J Shoulder Elbow Surg.
2013; 22(2):240-6.
7. Evaniew N, Simunovic N, McKee MD, Schemitsch E.
Cochrane in CORR(R): surgical versus conservative
interventions for treating fractures of the middle
third of the clavicle. Clin Orthop Relat Res. 2014;
472(9):2579-85.
8. Hill JM, McGuire MH, Crosby LA. Closed treatment of
displaced middle-third fractures of the clavicle gives
poor results. J Bone Joint Surg Br. 1997; 79(4):537-9.
9. Nowak J, Holgersson M, Larsson S. Sequelae from 
clavicular fractures are common: a prospective study
of 222 patients. Acta Orthop. 2005; 76(4):496-502.
10. Lenza M, Buchbinder R, Johnston RV, Belloti JC,
Faloppa F. Surgical versus conservative interventions
for treating fractures of the middle third of the
clavicle. Cochrane Database Syst Rev. 2013; 6(6):
CD009363.
11. Wijdicks FJ, Van der Meijden OA, Millett PJ,
Verleisdonk EJ, Houwert RM. Systematic review of the
complications of plate fixation of clavicle fractures.
Arch Orthop Trauma Surg. 2012; 132(5):617-25.
12. Leroux T, Wasserstein D, Henry P, Khoshbin A, Dwyer
T, Ogilvie-Harris D, et al. Rate of and risk factors
for reoperations after open reduction and internal
fixation of midshaft clavicle fractures: a populationbased
study in Ontario, Canada. J Bone Joint Surg
Am. 2014; 96(13):1119-25.
13. Ban I, Branner U, Holck K, Krasheninnikoff M,
Troelsen A. Clavicle fractures may be conservatively
treated with acceptable results - a systematic review.
Dan Med J. 2012; 59(7):A4457.
14. Poigenfurst J, Rappold G, Fischer W. Plating of fresh
clavicular fractures: results of 122 operations. Injury.
1992; 23(4):237-41.
15. Ring D, Holovacs T. Brachial plexus palsy after
intramedullary fixation of a clavicular fracture. A
report of three cases. J Bone Joint Surg Am. 2005;
87(8):1834-7.
16. Canadian Orthopaedic Trauma Society. Nonoperative
treatment compared with plate fixation of displaced
midshaft clavicular fractures. A multicenter,
randomized clinical trial. J Bone Joint Surg Am. 2007;
89(1):1-10.
The Archives of Bone and Joint Surgery
Volume 7, Issue 5
September 2019
Pages 402-406

Files

History

  • Receive Date: 10 April 2017
  • Revise Date: 24 December 2018
  • Accept Date: 19 January 2019

Share

How to cite

Statistics