Transverse, Z-type fractures linked with complications after clavicle fracture surgery
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TAMPA, Fla. — Results showed patients who undergo operative fixation of transverse or Z-type midshaft clavicle fractures may be at an increased risk for postoperative complications and may be better suited for a nonoperative approach.
“Optimal management of displaced midshaft clavicle fractures remains controversial,” Albert Lin, MD, said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting. “Historically, nearly all midshaft clavicle fractures were treated nonsurgically, and then we had studies in the mid-2000s that demonstrated higher nonunion rates and potentially decreased functional outcomes with nonoperative treatment, which in turn led to a recent rise in ORIF [open reduction and internal fixation],” he added.
Lin and colleagues from the department of orthopaedics at the University of Pittsburgh retrospectively reviewed data for 354 patients (mean age of 38 years) who underwent ORIF for a midshaft clavicle fracture between 2007 and 2019 with an average follow-up of 3 months.
According to the abstract, outcome measures included major postoperative complications, such as reoperation, and minor postoperative complications, such as sensory deficit, superficial wound infection and delayed union. Lin and colleagues also performed Chi-square analysis to identify predictors of complications.
Overall, there were 157 transverse fractures (44.4%), 147 oblique fractures (41.5%) and 50 Z-type fractures (14.1%). Of the 285 patients who reported their occupations, 93 (32.6%) worked in manual labor. Of the minor complications, there were 25 cases of sensory deficits, 11 cases of superficial wound infection and three cases of delayed union. Of the major complications, there were five cases of nonunion, four cases of symptomatic hardware and three cases of infection.
Fracture pattern was the only significant predictor of postoperative complications among the cohort, with complications occurring more frequently in patients with transverse and Z-type fractures, Lin noted.
“In these patients where operative indications are not obvious, strong consideration should be made for nonoperative management,” he concluded.
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Lin A, et al. Paper 24. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Dec. 15-17, 2021; Tampa, Fla.
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