Prognostic Factors for Reoperation After Plate Fixation of the Midshaft Clavicle
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Résumé
OBJECTIVES: To determine which prognostic factors were associated with an increased risk for all-cause reoperation in a heterogeneous population of patients treated with primary plate fixation of a midshaft clavicular fracture. DESIGN: Retrospective observational study. SETTING: Single university-affiliated tertiary care Level 1 trauma center. PATIENTS: Of 235 consecutive patients with primary plate fixation for a midshaft clavicular fracture. A reviewer extracted data through a retrospective chart review regarding 20 possible prognostic variables and documented reoperations (defined as any surgical procedure after the initial surgery, including implant removal, bone grafts, implant exchanges, or debridement for infection). INTERVENTION: Open reduction and internal fixation of the clavicle using straight and precontoured clavicle plates. MAIN OUTCOME MEASUREMENTS: Complete 2-year follow-up information was available for 153 of 235 patients (65%). Of these 153 patients included in the analysis, 58 (38%) had reoperations. The preoperative risk factors for 3 specific "reoperation outcomes" were examined: (1) reoperation for implant removal alone; (2) reoperation for nonunion, infection, or fixation failure; and (3) multiple reoperations. RESULTS: There was a significant reoperation rate in this patient series (58 of 153 patients, 38%). Although most were for isolated plate removal (42 of 153 patients, 27%), there were a minority of patients who required more complex (16 of 153 patients, 10%) or multiple (8 of 153 patients, 5%) procedures. For these 3 possible outcomes (reoperation for implant removal alone, reoperation for nonunion, infection, or fixation failure, and the need for multiple reoperations), significant risk factors were identified that can assist surgeons in patient selection and predicting reoperation after plate fixation of midshaft clavicle fractures. The significant risk factors for implant removal alone (42 of 153, 27%) were the use of a plate that was not precontoured and patient height <175 cm. The significant risk factors for reoperation for nonunion, infection, or fixation failure (16 of 153, 10%) were illicit drug use, diabetes, and previous surgery of the shoulder. The significant risk factors for multiple reoperations (8 of 153, 5%) were age >55 years and alcohol use >15 drinks per week. CONCLUSIONS: The use of precontoured plates can decrease the rate of hardware removal after primary fixation of displaced fractures of the midshaft clavicle. Also, specific preoperative prognostic factors may be used to counsel patients, maximize outcomes, minimize serious complications, and limit revision surgery. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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