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Kim H, Oh T, Lee SK. Do multiple fractures affect risk of fixation failure after surgical treatment of midshaft clavicle fracture? A retrospective cohort study. Arch Orthop Trauma Surg 2024; 144:121-130. [PMID: 37698623 DOI: 10.1007/s00402-023-05039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgical treatment of midshaft clavicle fractures is associated with quick recovery and low risk of non-union. However, fixation failure may occur in case of severe comminution fractures. Moreover, clinical outcomes may be affected when clavicle fractures occur in combination with other injuries, particularly those involving the lower extremities, as the use of crutches or walkers may hinder the process of rehabilitation by adding strain on the acromioclavicular (AC) joint, resulting in possible fixation failure. This study aims to identify risk factors for fixation failure of midshaft clavicle fractures and elucidate the role of combined fractures in treatment outcomes. METHODS This study included patients diagnosed with midshaft clavicle fractures who underwent initial surgery between January 2012 and November 2021 at a designated regional trauma center hospital. Retrospective evaluation of fixation failure was carried out in 352 patients with midshaft clavicle fractures using standard clinical evaluation protocols and conventional radiographs. The prevalence of fixation failure and the effects of several demographic variables on the risk of fixation failure and non-union were examined. Multivariate logistic regression analysis was carried out to identify independent risk factors for fixation failure. RESULTS Fixation failure occurred in 40 patients (11.4%). Multivariate analysis identified comminution [odds ratio (OR) 3.532, p value = 0.003, 95% confidence interval (CI) 1.55-8.05)] and fewer number of screws (OR 0.223, p value = 0.022, 95% CI 0.06-0.80) as risk factors for fixation failure. Surgical techniques using wire cerclage reduced the chances of fixation failure in comminuted fractures (OR 0.63, p value = 0.033, 95% CI 0.05-0.80). Combined fractures that required rehabilitation using walkers or crutches increased the risk of non-union (OR 19.043, p value = 0.032, 95% CI 1.28-282.46). CONCLUSIONS Additional fixation of comminuted fractures using cerclage can reduce the risk of treatment failure, while multiple fractures or rehabilitation for ambulation increases the risk of the same. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Taeho Oh
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Sang Ki Lee
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Republic of Korea.
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Irfan SA, Ali AA, Ashkar A, Akram U, Fatima S, Baig MMA, Khan MW. Predictors requiring special attention to prevent clavicle fracture nonunion: a systematic review of literature. Trauma Surg Acute Care Open 2023; 8:e001188. [PMID: 38020862 PMCID: PMC10679979 DOI: 10.1136/tsaco-2023-001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background Clavicle fracture (CF) is the tenth most prevalent fracture, accounting for an annual incidence of 37/10,000. This systematic review highlights the factors contributing to the nonunion union of the clavicular fracture. Method A systematic search was conducted using three web-based databases up to August 12, 2022, for conducting qualitative analysis. Articles were screened for relevance, and only studies that met inclusion criteria based on PECOS; P (patients): participants diagnosed with clavicular fracture; E (exposure): nonunion, C (control): not applicable; O (outcomes): factors contributing to nonunion or delayed union; S (studies): trials and observational studies. The Newcastle-Ottawa Scale was used to assess the quality of the cohort studies. The Cochrane risk of bias tool was used to assess the bias in randomized control trials. Results Ten studies were selected after the final literature search. Two thousand seven hundred and sixty-six adult participants who were radiologically and clinically diagnosed with nonunion clavicular fracture were included to pool the qualitative results. Fall was the most dominant cause of clavicular fracture, followed by road traffic collisions. Open reduction was widely used to treat nonunion correction. The qualitative results suggested a prominent correlation of nonunion with advancing age, female gender, high energy trauma, high Disabilities of the Arm, Shoulder, and Hand Score, smoking, fracture displacement, clavicular shortening, the callus on radiography, and fracture movement. The mid-shaft fracture was the most dominant type of fracture in the included studies; highly associated with nonunion in comparison to medial or lateral CF. The previous history of operation was an independent factor contributing to nonunion. Conclusion The results of this systematic review suggested the predictors contributing to nonunion in the CF. Demographic factors such as advancing age with female gender are at higher risk of developing clavicular nonunion. Smoking was the most dominantly highlighted environmental factor contributing to nonunion. Diaphyseal or midshaft fracture was the most common site for nonunion. Therefore, we suggested that patients with the predictors mentioned above require special attention to prevent nonunion of the CFs. More studies should be conducted on this subject to assess the factors that pose a risk associated with the nonunion of the bone for better clinical management and outcomes of the fracture.
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Affiliation(s)
- Shayan Ali Irfan
- Orthopedic, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Abid Anwar Ali
- Orthopedic, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Anusha Ashkar
- Orthopedic, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Usama Akram
- Orthopedic, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Sameen Fatima
- Orthopedic, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Mirza M Ali Baig
- Orthopedic, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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Dietrich G, Terrier A, Favre M, Elmers J, Stockton L, Soppelsa D, Cherix S, Vauclair F. Influence of smoking on the healing of conservatively treated displaced midshaft clavicle fractures. Bone Joint J 2023; 105-B:801-807. [PMID: 37391206 DOI: 10.1302/0301-620x.105b7.bjj-2022-1336.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Aims Tobacco, in addition to being one of the greatest public health threats facing our world, is believed to have deleterious effects on bone metabolism and especially on bone healing. It has been described in the literature that patients who smoke are approximately twice as likely to develop a nonunion following a non-specific bone fracture. For clavicle fractures, this risk is unclear, as is the impact that such a complication might have on the initial management of these fractures. Methods A systematic review and meta-analysis were performed for conservatively treated displaced midshaft clavicle fractures. Embase, PubMed, and Cochrane Central Register of Controlled Trials (via Cochrane Library) were searched from inception to 12 May 2022, with supplementary searches in Open Grey, ClinicalTrials.gov, ProQuest Dissertations & Theses, and Google Scholar. The searches were performed without limits for publication date or languages. Results The meta-analysis included eight studies, 2,285 observations, and 304 events (nonunion). The random effects model predicted a pooled risk ratio (RR) of 3.68 (95% confidence interval 1.87 to 7.23), which can be considered significant (p = 0.003). It indicates that smoking more than triples the risk of nonunion when a fracture is treated conservatively. Conclusion Smoking confers a RR of 3.68 for developing a nonunion in patients with a displaced middle third clavicle fracture treated conservatively. We know that most patients with pseudarthrosis will have pain and a poor functional outcome. Therefore, patients should be informed of the significantly higher risks of nonunion and offered smoking cessation efforts and counselling. Moreover, surgery should be considered for any patient who smokes with this type of fracture.
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Affiliation(s)
- Gilles Dietrich
- Department of Orthopaedic Surgery & Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Terrier
- Department of Orthopaedic Surgery & Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Laboratory of Biomechanical Orthopaedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Melissa Favre
- Department of Orthopaedic Surgery & Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jolanda Elmers
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurie Stockton
- Department of Orthopaedic Surgery & Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dino Soppelsa
- Department of Orthopaedic Surgery & Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedic Surgery & Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Vauclair
- Department of Orthopaedic Surgery & Traumatology, Bone and Motion Center, Hirslanden Clinique Bois-Cerf, Lausanne, Switzerland
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Mittermayr R, Haffner N, Eder S, Flatscher J, Schaden W, Slezak P, Slezak C. Safe and Effective Treatment of Compromised Clavicle Fracture of the Medial and Lateral Third Using Focused Shockwaves. J Clin Med 2022; 11:1988. [PMID: 35407594 PMCID: PMC8999686 DOI: 10.3390/jcm11071988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
A delay or failure to heal is the most common possible complication in clavicle fractures, especially in cases primarily treated conservatively. As the current standard therapy, surgical revision achieves good healing results, but is associated with potential surgery-related complications. Shockwave therapy as a non-invasive therapy shows similar reasonable consolidation rates in the non-union of different localizations, but avoids complications. Compromised clavicle fractures in the middle and lateral third treated with focused high-energy shockwave therapy were compared with those treated with surgical revision (ORIF). In addition, a three-dimensional computer simulation for evaluating the pressure distribution during shockwave application accompanied the clinical study. A comparable healing rate in bony consolidation was achieved in both groups. Significantly fewer complications, however, occurred in the shockwave group. The simulations showed safe application in this instance, particularly in avoiding lung tissue affection. When applied correctly, shockwaves represent a safe and promising therapy option for compromised clavicle fractures in the middle and lateral third.
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Zhang D, Dyer GSM, Earp BE. Factors Associated With Surgical Treatment of Isolated, Displaced Midshaft Clavicle Fractures. Orthopedics 2021; 44:e515-e520. [PMID: 34292821 DOI: 10.3928/01477447-20210618-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the current available evidence, surgical treatment of isolated, displaced midshaft clavicle fractures is discretionary. The aim of this study was to determine whether there are identifiable factors associated with the surgical treatment of isolated, displaced midshaft clavicle fractures. A retrospective cohort study of 150 patients who underwent nonoperative treatment and 290 patients who underwent surgical treatment of isolated, displaced midshaft clavicle fractures from January 2010 to March 2019 at 2 level I trauma centers was performed. Multivariable regression analysis demonstrated that younger age (odds ratio [OR], 0.97; 95% CI, 0.95-0.99), absence of diabetes mellitus (OR, 0.045; 95% CI, 0.003-0.79), nonsmoking status (OR, 0.31; 95% CI, 0.13-0.75), higher American Society of Anesthesiologists classification (OR, 5.0; 95% CI, 2.7-9.2), fracture comminution (OR, 2.3; 95% CI, 1.3-3.9), and fracture displacement (OR, 1.1; 95% CI, 1.0-1.1) were associated with surgical treatment of an isolated, displaced midshaft clavicle fracture. Furthermore, lower social deprivation (OR, 0.99; 95% CI, 0.97-0.99) and private insurance compared with Medicare (OR, 6.6; 95% CI, 1.6-27) were associated with surgical treatment. The authors conclude that surgical treatment of discretionary midshaft clavicle fractures is influenced by patient factors, fracture characteristics, and socioeconomic factors. Further study is needed to understand the etiology of social disparities in clavicle surgery and rectify unintended trends in treatment. [Orthopedics. 2021;44(4):e515-e520.].
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Firoozabadi R, Wilkerson J, Hemingway J, Tran N. Axillary Artery Pseudoaneurysm After Revision Plate Osteosynthesis of a Midshaft Clavicle Fracture Nonunion: A Case Report. JBJS Case Connect 2020; 10:e19.00591. [PMID: 37475452 DOI: 10.2106/jbjs.cc.19.00591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
CASE A patient with history of nonunion repair of traumatic midshaft clavicle fracture was referred to our orthopaedic trauma clinic for new-onset shoulder pain and paresthesias involving the ipsilateral arm. Computed tomography angiography revealed an axillary artery pseudoaneurysm adjacent to the instrumentation and recurrent nonunion of the fracture site. The patient underwent coil embolization of the pseudoaneurysm and nonunion repair. CONCLUSION This case demonstrates that iatrogenic neurovascular injury during clavicle fracture nonunion repairs can present in a delayed fashion requiring more thorough clinical and imaging evaluation to achieve successful treatment.
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Affiliation(s)
- Reza Firoozabadi
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, Washington
| | - Jacob Wilkerson
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, Washington
| | - Jake Hemingway
- Department of Vascular Surgery, University of Washington, Seattle, Washington
| | - Nam Tran
- Department of Vascular Surgery, University of Washington, Seattle, Washington
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Furuhata R, Takahashi M, Hayashi T, Inagawa M, Kono A, Matsumura N, Kamata Y, Arino H, Morioka H. Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases. BMC Musculoskelet Disord 2020; 21:146. [PMID: 32131803 PMCID: PMC7057610 DOI: 10.1186/s12891-020-3169-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after 7 days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes. Results Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P = 0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures. In addition, this study suggested that performing surgery within 6 days after injury is recommended to reduce postoperative complications.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Masaaki Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Teppei Hayashi
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Miyu Inagawa
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Aki Kono
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yusaku Kamata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Hiroshi Arino
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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Moverley R, Little N, Gulihar A, Singh B. Current concepts in the management of clavicle fractures. J Clin Orthop Trauma 2020; 11:S25-S30. [PMID: 31992912 PMCID: PMC6978197 DOI: 10.1016/j.jcot.2019.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022] Open
Abstract
Clavicle fractures comprise approximately 3% of all adult fractures and there is evidence that the incidence is increasing. Fractures of the lateral and middle third of the clavicle present distinct challenges in both surgical fixation techniques and clinical outcome, as such they should be recognised as separate clinical entities. Despite conflicting evidence, most studies indicate that superior clinical results are found in patients with united clavicle fractures rather than those that go onto non-union. Furthermore there is level-1 evidence that operative treatment of clavicle fractures leads to significantly increased rates of union. Despite these findings, significant controversy still exists on which patients would benefit from primary fixation and those who could successfully be managed non-operatively. We present an evidence-based review of clavicle fracture management including surgical indications, techniques, and results.
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Affiliation(s)
| | - Nick Little
- Epsom & St Helier Hospitals NHS Trust, London, UK
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Brandariz RN, Bruchmann MG, De Cicco FL, Rossi LA, Tanoira I, Ranalletta M. Coracoclavicular Double-Button Fixation of Displaced Lateral Clavicular Fracture in a Patient without Coracoid Process. Case Rep Orthop 2019; 2019:6506951. [PMID: 31934482 DOI: 10.1155/2019/6506951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Displaced distal clavicular fractures are generally operated on because of the high nonunion rate after nonoperative treatment. Several surgical techniques have been developed to reduce the nonunion rate and improve functional outcomes. One of them is closed reduction and minimally invasive coracoclavicular double-button fixation, which requires the integrity of the coracoid process to be performed. Case Summary We present a 35-year-old male patient who had been successfully subjected to a modified Latarjet procedure for glenohumeral instability with bony defect treatment, and 7 months later suffered a distal clavicle fracture in his ipsilateral shoulder. With a CT scan, we analyzed the coracoid remnant size (7 mm), and we consider it enough to perform a minimally invasive double-button technique, using this remnant as a distal fixation. Postoperative and Follow-Up Radiographic and clinical fracture union occurred 10 weeks after the procedure. The patient returned to sports at the same level he had before surgery and achieved full strength and range of motion. Conclusion Closed reduction and minimally invasive double-button fixation of displaced distal clavicular fractures is a safe, reproducible, and versatile technique, which can even be performed without an intact coracoid process.
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Ince I, Kilicaslan A, Roques V, Elsharkawy H, Valdes L. The clavipectoral fascia plane block: Reply to Dr. Altinpulluk. J Clin Anesth 2019; 61:109681. [PMID: 31831283 DOI: 10.1016/j.jclinane.2019.109681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Ilker Ince
- Department of Anesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland Clinic, OH, USA.
| | - Alper Kilicaslan
- Department of Anesthesiology and Reanimation, School of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Vicente Roques
- Intensive Care and Chronic Pain Treatment, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Hesham Elsharkawy
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luis Valdes
- Department of Anesthesiology and Reanimation, Hospital Universitario Costa del Sol, Marbella, Spain
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Nicholson JA, Gribbin H, Clement ND, Robinson CM. Open reduction and internal fixation of clavicular fractures after a delay of three months is associated with an increased risk of complications and revision surgery. Bone Joint J 2019; 101-B:1385-1391. [PMID: 31674242 DOI: 10.1302/0301-620x.101b11.bjj-2019-0451.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to determine if delayed clavicular fixation results in a greater risk of operative complications and revision surgery. PATIENTS AND METHODS A retrospective case series was undertaken of all displaced clavicular fractures that underwent plate fixation over a ten-year period (2007 to 2017). Patient demographics, time to surgery, complications, and mode of failure were collected. Logistic regression was used to identify independent risk factors contributing towards operative complications. Receiver operating characteristic (ROC) curve analysis was used to determine if a potential 'safe window' exists from injury to delayed surgery. Propensity score matching was used to construct a case control study for comparison of risk. RESULTS A total of 259 patients were included in the analysis. Postoperative infection occurred in 3.9% of all patients (n = 10); the only variable associated was a greater time interval from injury to fixation (p = 0.001). Failed primary surgery requiring revision fixation was required in 7.7% of the cohort (n = 20), with smoking (p < 0.001), presence of a postoperative infection (p < 0.001), increasing age (p = 0.018), and greater time delay from injury to surgery (p = 0.015) identified as significant independent predictors on regression analysis. ROC analysis revealed that surgery beyond 96 days from injury increased the rate of major complications and revision surgery. Using a matched case cohort of cases before (n = 67) and after (n = 77) the 'safe window', the risk of postoperative infection increased (odds ratio (OR) 7.7, 95% confidence interval (CI) 1.9 to 62.9; p = 0.028), fixation failure (OR 3.8, 95% CI 1.2 to 12.1; p = 0.017) and revision surgery (OR 4.8, 95% CI 1.5 to 15.0; p = 0.004). CONCLUSION A delay to primary fixation of up to three months following injury may be acceptable, beyond which there is an increased risk of major operative complications and revision surgery. Cite this article: Bone Joint J 2019;101-B:1385-1391.
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Affiliation(s)
- Jamie A Nicholson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Harriet Gribbin
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
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