title: Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison.
abstract: OBJECTIVE
  The incidence of operative treatment of dislocated midshaft clavicle fractures (DMCF) is rising due to unsatisfactory results after non-operative treatment. Knowledge of complications is important for selection of the surgical technique and preoperative patient counselling. The aim of this study is to compare complications after plate fixation and elastic stable intramedullary nailing (ESIN) with a titanium elastic nail (TEN) for DMCF.
  
  
  METHODS
  A retrospective analysis of our surgical database was performed. From January 2005 to January 2010, 90 patients with DMCF were treated with plate fixation or ESIN. Complications were evaluated in both treatment groups and subsequently compared.
  
  
  RESULTS
  Seven implant failures occurred in six patients (14 %) of the plate group and one implant failure (2.1 %) was seen in the ESIN group (p = 0.051). Major revision surgery was performed in five cases in the plate group (11.6 %) and in one case (2.1 %) in the ESIN group (p = 0.100). Three refractures (7.0 %) were observed in the plate group after removal of the implant against none in the ESIN group (p = 0.105). Six minor revisions (13 %) were reported in the ESIN group and none were reported in the plate group (p = 0.027).
  
  
  CONCLUSIONS
  Compared to other studies we report higher rates of refracture (7.0 %), major revision surgery (11.6 %) and implant failure (14.0 %) after plate fixation. The frequency of implant failures differed almost significantly for patients treated with plate fixation compared to ESIN. Furthermore, a tendency towards refracture after implant removal and major revision surgery after plate fixation was observed.
authors: Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands. fjgwijdicks@gmail.com
authors: Frans-Jasper
authors: FJ
authors: Wijdicks
authors: Marijn
authors: M
authors: Houwert
authors: Marcel
authors: M
authors: Dijkgraaf
authors: Diederik
authors: D
authors: de Lange
authors: Koen
authors: K
authors: Oosterhuis
authors: Geertjan
authors: G
authors: Clevers
authors: Egbert-Jan
authors: EJ
authors: Verleisdonk
mesh_terms: D000328:Adult; D017760:Bone Malalignment / Q000473:pathology / Q000601:surgery; D001858:Bone Nails; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D004548:Elasticity; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000473:pathology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D014025:Titanium; D014193:Trauma Centers; D016896:Treatment Outcome
chemical_list: D014025:Titanium