title: Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures.
abstract: BACKGROUND
  Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013. Patients were stratified by operative indication: acute fracture or nonunion. Patient characteristics and 30-day complication rates were compared between the 2 groups using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 1215 patients were included in our analysis. Of these, 1006 (82.8%) were acute midshaft clavicle fractures and 209 (17.2%) were midshaft nonunions. Patients undergoing surgical fixation for nonunion had a higher rate of total complications compared with the acute fracture group (5.26% vs. 2.28%; P = .034). On multivariate analysis, patients with a nonunion were at a >2-fold increased risk of any postsurgical complication (odds ratio, 2.29 [95% confidence interval, 1.05-5.00]; P = .037) and >3-fold increased risk of a wound complication (odds ratio, 3.22 [95% confidence interval, 1.02-10.20]; P = .046) compared with acute fractures.
  
  
  CONCLUSIONS
  On the basis of these findings, patients undergoing surgical fixation for a midshaft clavicle nonunion are at an increased risk of short-term complications compared with acute fractures. This study provides additional information to consider in making management decisions for these common injuries.
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA. Electronic address: mcknight.braden@gmail.com.
authors.forename: Braden
authors.initials: B
authors.lastname: McKnight
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Heckmann
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: J Ryan
authors.initials: JR
authors.lastname: Hill
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Pannell
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA; Huntington Hospital, Pasadena, CA, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Mostofi
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Omid
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: George F Rick
authors.initials: GF
authors.lastname: Hatch
mesh_terms: D000328:Adult; D002968:Clavicle / Q000293:injuries*; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Clavicle; NSQIP; complication rate; database; nonunion; retrospective