Complications of plate fixation in fresh displaced midclavicular fractures.
BACKGROUND
The role of plate fixation in the management of fresh displaced midclavicular fractures is unsettled. The objective of this study was to evaluate the drawbacks and pitfalls of this treatment method.


METHODS
We analyzed the complications encountered in 103 consecutive adult patients with severely displaced fresh fractures of the middle third of the clavicle who were treated by open reduction and internal fixation using AO/ASIF plates. These 103 patients accounted for 9.5% of the 1,081 patients with fresh midclavicular fractures seen between 1989 and 1995. The mean age of the 103 patients was 33.4 years (range, 19-62 years).


RESULTS
Seventy-nine patients had an uneventful recovery, whereas 24 (23%) suffered one or several complications. The major complications included deep infection, plate breakage, nonunion, and refracture after plate removal. The most common of the minor complications was plate loosening resulting in malunion. The infection rate was 7.8%. A total of 14 reoperations were performed because of the complications. Permanent nonunion ensued in two patients. A severely comminuted fracture (relative risk of failure, 5.15) as well as a state of alcohol intoxication on admission (relative risk of failure, 3.12) were identified as markers of increased complication risk.


CONCLUSIONS
Patient noncompliance with the postoperative regimen could be suspected to have been a major cause of the failures. The high complication rate supports a reserved attitude toward plate fixation of fresh midclavicular fractures. The method should be reserved for patients who have trustworthy personal motives for quick pain relief and functional recovery.
Böstman
O
O
Department of Orthopedic and Trauma Surgery, Helsinki University Hospital, Finland.
Manninen
M
M
Pihlajamäki
H
H
D000328:Adult; D000435:Alcoholic Intoxication / Q000150:complications; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012086:Reoperation; D017211:Treatment Failure; D016312:Treatment Refusal