What is the hardware removal rate after anteroinferior plating of the clavicle? A retrospective cohort study

• Published in: Journal of shoulder and elbow surgery Vol. 26; no. 10; pp. 1838 - 1843
• Main Authors: Baltes, Thomas P.A., BSc, Donders, Johanna C.E., MD, Kloen, Peter, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Adult; Aged; Aged, 80 and over; anteroinferior plating; Bone Plates - adverse effects; Clavicle; Clavicle - injuries; Device Removal; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fractures, Bone - surgery; hardware removal; Humans; irritation; Male; Middle Aged; midshaft; Orthopedics; plate fixation; Retrospective Studies; Young Adult; Treatment Study; Level IV; anteroinferior plating; Clavicle; hardware removal; Case Series; midshaft; plate fixation; irritation
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2017.03.011

Background Plate position in the operative treatment of displaced midshaft clavicle fractures or nonunions is most often on the superior side. However, superior clavicular plating often results in complaints of plate prominence and local soft tissue irritation, necessitating hardware removal. We have used anteroinferior placement of the plate in the hope of increasing biomechanical stability and fixation and also of lowering complaints of plate prominence and soft tissue irritation. In this report, we set out to study the percentage of hardware removal in our group of patients treated with anteroinferior plating of the clavicle after long-term follow-up. Methods In this retrospective review, we evaluated all patients who were surgically treated with anteroinferior plating for midshaft clavicle fracture, delayed union, or nonunion by the senior author between February 2003 and July 2015. Patients required a minimum age of 16 years at time of surgery and a follow-up of >12 months. Patients with malunion, plating on the superior aspect, or double plating were excluded. Results The medical records of 53 patients (54 fractures) were reviewed after a mean follow-up duration of 6.4 years (range, 1.1-13.1). The mean age at follow-up was 47.8 years (range, 20.4-80.7). All fractures and nonunions healed. In only 3 cases (5.6%), hardware removal was requested by the patient because of plate prominence. Conclusions Anteroinferior plating of midshaft clavicle fractures, delayed unions, and nonunions resulted in low hardware removal rates in our cohort.