Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures.
BACKGROUND
The number of displaced midshaft clavicle fractures treated surgically is increasing, and open reduction and intramedullary fixation is an emerging surgical treatment option. The study quality and scientific levels of published evidence in which possible complications of this treatment are presented vary greatly.


METHODS
We performed systematic computer-based searches of EMBASE and PubMed/MEDLINE. Studies included for review reported complications after intramedullary fixation alone or in comparison to either treatment with plate fixation and/or nonoperative treatment. The Level of Evidence rating and Quality Assessment Tool were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence.


RESULTS
Six articles were eligible for inclusion and final quality assessment; 3 studies were graded the highest level of evidence. Major complications like bone-healing problems and deep infections requiring implant removal were reported at a rate no higher than 7%. Reported rates for minor complications, such as wound infection and implant irritation that could be resolved without further surgery, were as high as 31%.


CONCLUSIONS
The noted rates for major complications requiring additional surgery were low, but implant-related problems that require additional surgery might present with high prevalence. Owing to routine implant removal, treatment with intramedullary fixation often requires an additional surgical procedure.
The Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands. fjgwijdicks@gmail.com
Frans-Jasper G
FJ
Wijdicks
R M
RM
Houwert
Peter J
PJ
Millett
Egbert J J M
EJ
Verleisdonk
Olivier A J
OA
Van der Meijden
D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D015986:Confounding Factors, Epidemiologic; D020878:Device Removal; D019317:Evidence-Based Medicine; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D010027:Osteotomy; D012086:Reoperation; D016896:Treatment Outcome