Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures

Huang,Xiaoyan; Xiao,Haijun; Xue,Feng

doi:10.3892/etm.2019.8216

January-2020 Volume 19 Issue 1

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January-2020 Volume 19 Issue 1

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Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures

Authors:
- Xiaoyan Huang
- Haijun Xiao
- Feng Xue
View Affiliations / Copyright

Affiliations: Department of Orthopedics, Shanghai Fengxian District Central Hospital, Shanghai 201400, P.R. China

Copyright: © Huang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 308-312
|
Published online on: November 19, 2019

https://doi.org/10.3892/etm.2019.8216
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Abstract

Open reduction and plate fixation have been widely used for the treatment of displaced midshaft clavicular fractures (DMCF). The nonunion rate after plate fixation of DMCF has been reported to be between 0.1 and 15% and the construct failure rate is approximately 5%. Few studies have discussed the risk factors of construct failure. The aim of the present study was to identify possible risk factors of construct failure in plate fixation of DMCF and discuss the subsequent treatment strategies. Six patients who experienced plate breakage and clavicle nonunion between 2015 and 2017 were evaluated. All these patients were treated with open reduction and plate fixation of DMCF using a 3.5‑mm locking compression plate. The plate breakage occurred 3‑6 months after the initial injury. After the diagnosis of plate breakage, four patients underwent surgical management and two patients underwent nonoperative treatment. Potential risk factors for construct failure and efficacy of the subsequent treatment strategies were analyzed. We found that a risk factor for plate breakage was the increased stress in free hole area around the fracture zone. A second surgery for plate renewal and bone grafting may be necessary in a large percentage of these individuals. Based on the results of this study, our recommendation is that monocortical screws or simple obturators for the holes around the fracture zone should be used to protect the comminuted fragment for further damage and enhance plate strength. If a clavicle nonunion and plate breakage does occur, surgical repair and bone grafting provide high union rates and should be a necessary remedy.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures

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