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Poorer outcomes seen in patients with hardware removed after plate fixation for clavicle fractures
Although high union rates were seen in patients with midshaft clavicle fractures who underwent precontoured plate fixation, according to study results, patients who required hardware removal reported worse long-term outcomes than patients who retained hardware.
Researchers identified 7,826 patients from a private-payer national database who underwent clavicle open reduction and internal fixation (ORIF). Patients were followed for 2 years to evaluate hardware removal and revision fixation. Investigators also retrospectively identified 73 patients with midshaft clavicle fractures who underwent plate fixation at their institution. Patient-reported outcomes were assessed with the DASH, EQ-5D quality of life assessment and a survey on hardware-related outcomes.
Results showed among the 7,826 patients from the database, 994 patients required hardware removal, while 78 patients needed revision ORIF. From 2007 to 2011, the annual ORIF incidence increased by 61.5%.
Investigators noted 56 patients out of the 73 patients from their institution were treated with precontoured plates and 17 patients were treated with standard plates. Eleven patients at the mean follow-up of 4.2 years underwent hardware removal, and one patient had experienced nonunion.
According to researchers, patients reported excellent outcomes with an average DASH score of 4 and an EQ-5D of 0.89. No differences were seen in patient-reported outcomes, hardware removal or union rates between the plated groups; however, investigators said their study was underpowered for outcomes. Lower DASH, EQ-5D, satisfaction and shoulder function were reported in patients who underwent hardware removal compared with patients who retained hardware. Women had a four-times greater chance of hardware removal than men. ‒ by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.