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

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 r...

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Autores principales: Huang, Xiaoyan, Xiao, Haijun, Xue, Feng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: D.A. Spandidos 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909797/
https://www.ncbi.nlm.nih.gov/pubmed/31853304
http://dx.doi.org/10.3892/etm.2019.8216
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author Huang, Xiaoyan
Xiao, Haijun
Xue, Feng
author_facet Huang, Xiaoyan
Xiao, Haijun
Xue, Feng
author_sort Huang, Xiaoyan
collection PubMed
description 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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spelling pubmed-69097972019-12-18 Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures Huang, Xiaoyan Xiao, Haijun Xue, Feng Exp Ther Med Articles 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. D.A. Spandidos 2020-01 2019-11-19 /pmc/articles/PMC6909797/ /pubmed/31853304 http://dx.doi.org/10.3892/etm.2019.8216 Text en Copyright: © Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Articles
Huang, Xiaoyan
Xiao, Haijun
Xue, Feng
Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
title Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
title_full Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
title_fullStr Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
title_full_unstemmed Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
title_short Clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
title_sort clavicle nonunion and plate breakage after locking compression plate fixation of displaced midshaft clavicular fractures
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909797/
https://www.ncbi.nlm.nih.gov/pubmed/31853304
http://dx.doi.org/10.3892/etm.2019.8216
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