title: Symptomatic Implant Removal Following Dual Mini-Fragment Plating for Clavicular Shaft Fractures.
abstract: OBJECTIVE
  To determine the proportion of patients requiring secondary surgery for symptomatic implant removal after open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Single university Level 1 trauma center.
  
  
  METHODS
  Eighty-one patients treated with open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures (OTA/AO 15-B1, B2, and B3) with minimum 12-month follow-up (median 477 days; range 371-1549 days).
  
  
  METHODS
  Open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures.
  
  
  METHODS
  Incidence of secondary surgery, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) scores.
  
  
  RESULTS
  Six of 81 patients (7.4%) underwent secondary surgery for implant removal for any reason. Of these, 3 (3.7%) underwent symptomatic implant (soft-tissue irritation) removal, 2 (2.5%) required implant removal in the setting of infection, and 1 patient (1.2%) required revision open reduction internal fixation for early implant failure. The mean QuickDASH score in this series was 8.44 (±6.94, range 0-77.27). The associated implant cost of the typical construct utilized in this series was $1511.38. The mean surgical time was 97 minutes (range 71-143 minutes).
  
  
  CONCLUSIONS
  The utilization of a dual mini-fragment plating technique in the treatment of clavicular shaft fractures results in a low rates of secondary surgery for symptomatic implant removal (3.7%) and similar QuickDASH scores when compared with historical controls treated with 3.5-mm plates placed on the superior clavicle. Potential disadvantages in using this technique include a higher surgical implant cost and length of surgery.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, University of Texas at Houston, Houston, TX; and †Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Czajka
authors.forename: Andrew
authors.initials: A
authors.lastname: Kay
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Gary
authors.forename: Mark L
authors.initials: ML
authors.lastname: Prasarn
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Choo
authors.forename: John W
authors.initials: JW
authors.lastname: Munz
authors.forename: William H
authors.initials: WH
authors.lastname: Harvin
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Achor
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001860:Bone Plates / Q000706:statistics & numerical data; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D015897:Comorbidity; D020878:Device Removal / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D008904:Miniaturization; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D063189:Symptom Assessment; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult