Systematic review of the complications of plate fixation of clavicle fractures

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Clavicle fractures in adults occur quite frequently; approximately 5% of all fractures concern the clavicle. The vast majority of fractures, approximately 80%, is located in the midshaft of the clavicle and half of these fractures are displaced.

In the past, treatment of choice for most midshaft clavicle fractures was nonoperative with a sling or figure-of-eight bandage. Reported nonunion rates following surgical fixation of clavicle fractures were initially higher than those reported following nonoperative treatment. More recent studies, however, suggest higher complication and nonunion rates of up to 15% following nonoperative treatment, in particular for patients with displaced midshaft clavicle fractures (DMCF). In addition, these patients are at high risk of residual pain, disappointing cosmesis and shoulder dysfunction.

A regularly used surgical treatment option for DMCF is plate fixation. An advantage of plate fixation is the immediate stability it provides which enables early post- operative mobilization. Several types of plates and fixation methods have been previously described; these include (precontoured) dynamic compression plates (DCP), tubular plates or reconstruction plates. Although high success rates of plate fixation of displaced clavicle fractures have been shown, reported complications of plate fixation include implant failure, (deep) infections, implant prominence, poor cosmesis, nonunions and refracture as a result of removal of the plate. The study quality and scientific levels of evidence at which complications are presented, however, vary greatly in literature. Different reviews are performed on clavicle fractures, but none of these reviews specifically address the complications of plate fixation for dislocated midshaft clavicular fractures.

This systematic review aims at answering the following questions: (1) What is the incidence of minor and major complications after surgical plate fixation of acute DMCF? (2) What is the value of reported complications in terms of the scientific level of evidence at which they are presented? (3) What are the frequency and severity of the long-term consequences of major complications after plate fixation? (4) what conclusions may be drawn from these findings and how may it influence treatment of midshaft clavicle fractures?

Full Article: Systematic review of the complications of plate fixation of clavicle fractures