title: Reconstruction plates for midshaft clavicular fractures: A retrospective cohort study.
abstract: BACKGROUND
  For the fixation of displaced midshaft clavicular fractures different plates are available, each with its specific pros and cons. The ideal plating choice for this lesion remains subject to ongoing discussion. Reconstruction plates are cheap and easily bendable, but their strength and stability have been questioned. The aim of this study was to evaluate the failure rate of reconstruction plates in the fixation of clavicular fractures.
  
  
  METHODS
  A multicenter, retrospective cohort study of all consecutive patients with a displaced, midshaft clavicular fracture (Robinson type 2a/2b) treated with a 3.5-mm reconstruction plate between 2006 and 2013 were evaluated. The primary outcome measure was reoperation rate due to implant failure. Secondary outcome measures were nonunion, symptomatic malunion and elective plate removal.
  
  
  RESULTS
  One hundred and eleven patients were analyzed. During a median follow-up of 8 months, 14 patients (12.6%) had implant failure, of which 7 (6.3%) required a reoperation. Three nonunions (2.7%) and no symptomatic malunions occurred. Plate removal was indicated in 37.8% of patients because of implant irritation.
  
  
  CONCLUSIONS
  The incidence of reoperation due to implant failure following clavicular plate fixation with a reconstruction plate is 6.3%. Although comparison with other plate types is difficult since rates in literature vary greatly, reoperation rates in other plates are reported around 2-3%, suggesting that reconstruction plates have a higher incidence of implant failure warranting reoperation. Therefore, especially in patients with known risk factors for complications (e.g. smoking, osteoporosis, comminuted fractures), a stronger plate than a reconstruction plate should be considered.
  
  
  METHODS
  Level IV. Retrospective study.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.woltz@lumc.nl.
authors.forename: S
authors.initials: S
authors.lastname: Woltz
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Duijff
authors.affiliation: Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Hoogendoorn
authors.affiliation: Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rhemrev
authors.affiliation: Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Breederveld
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
authors.affiliation: Luzerner Kantonsspital, Luzern, Switzerland.
authors.forename: F J P
authors.initials: FJ
authors.lastname: Beeres
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Clavicular fracture; Implant failure; Reconstruction plate; Reoperation