title: Complications associated with operative fixation of acute midshaft clavicle fractures.
abstract: BACKGROUND
  The aim of this study was to review the complication rate and profile associated with surgical fixation of acute midshaft clavicle fracture in a large cohort of patients treated in a level I trauma centre.
  
  
  METHODS
  We identified all patients who underwent surgical treatment of acute midshaft clavicle fracture between 2002 and 2010. The study group consisted of 138 fractures (134 patients) and included 107 men (78%) and 31 women (22%); the median age of 35 years (interquartile range (IQR) 24-45). The most common mechanism of injury was a road traffic accident (78%). Sixty percent (n=83) had an injury severity score of ≥15 indicating major trauma. The most common fracture type (75%) was simple or wedge comminuted (2B1) according to the Edinburgh classification. The median interval between the injury and operation was 3 days (IQR 1-6). Plate fixation was performed in 110 fractures (80%) and intramedullary fixation was performed in 28 fractures (20%). There were 85 men and 25 women in the plate fixation group with median age of 35 years (IQR 25-45) There were 22 men and six women in the intramedullary fixation group with median age of 31 years (IQR 24-42 years). Statistical analysis was performed using independent sample t test, Mann Whitney test, and Chi square test. Significant P-value was <0.05.
  
  
  RESULTS
  The overall incidence of complication was 14.5% (n=20). The overall nonunion rate was 6%. Postoperative wound infection occurred in 3.6% of cases. The incidence of complication associated with plate fixation was 10% (11 of 110 cases) compared to 32% associated with intramedullary fixation (nine of 28 cases; P=0.003). Thirty-five percent of complications were related to inadequate surgical technique and were potentially avoidable. Symptomatic hardware requiring removal occurred in 23% (n=31) of patients. Symptomatic metalware was more frequent after plate fixation compared to intramedullary fixation (26% vs 7%, P=0.03).
  
  
  CONCLUSIONS
  Intramedullary fixation of midshaft clavicle fracture is associated with a higher incidence of complications. Plate fixation is associated with a higher rate of symptomatic metalware requiring removal compared to intramedullary fixation. Approximately one in three complications may be avoided by attention to adequate surgical technique.
authors.affiliation: Nepean Hospital, Sydney, Australia. Electronic address: saeedasadollahi@yahoo.com.
authors.forename: Saeed
authors.initials: S
authors.lastname: Asadollahi
authors.affiliation: Northern Hospital, Melbourne, Australia. Electronic address: raphaelhau@hotmail.com.
authors.forename: Raphael C
authors.initials: RC
authors.lastname: Hau
authors.affiliation: University Hospital Geelong and School of Medicine, Deakin University, Geelong, Australia. Electronic address: richardpage@geelongortho.com.au.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Page
authors.affiliation: Department of Surgery, University of Melbourne, Epworth Hospital, Melbourne, Australia. Electronic address: orthovic@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Department of Orthopaedics, The Alfred Hospital, Melbourne, Australia. Electronic address: ere@bigpond.net.au.
authors.forename: Elton R
authors.initials: ER
authors.lastname: Edwards
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Clavicle fracture; Complication; Midshaft