Does anteroinferior fixation of midshaft clavicle fractures have lower rates of hardware removal or complications [presentation]?
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INTRODUCTION: The primary objective of this study was to compare hardware removal rates with plates positioned superiorly to those positioned anteroinferiorly. Secondary objectives were to report any significant correlation between hardware removal, complications demographics, fracture characteristics, or implant types as well as superior versus anteroinferior plating. METHODS: A retrospective study of 328 consecutive midshaft clavicle fractures treated by ORIF at three Level I trauma centers between 2006-2010 was performed. Electronic medical records and radiographic studies were reviewed to collect patient demographics, injury characteristics, operative techniques, and outcomes. RESULTS: Hardware removal was performed on 42/328 (12.8%) patients. Analysis comparing patients requiring HWR to those not requiring, revealed females had a statistically higher rate of HWR (P<0.001). Of the 328 fractures, 205 (62.5%) fractures were plated anteroinferiorly and 123 (37.5%) superiorly. Surprisingly, comparative analysis of anteroinferior plating and superior plating showed that hardware removal rates were higher for the anteroinferior group (15.3% vs. 10.7%); however, this difference was not significant (p=0.3). Of the 328 fractures, the rates of hardware failure, nonunion, and infection were 2.7%, 1.5%, and 0.9% respectively. Plate location, type, and size did not have an effect on nonunion or infection rate; however, there was a higher rate of hardware failure in patients with 2.7 mm plates compared to 3.5 mm (5.4% vs. 1.1%) (p<0.05). Additionally, reconstruction plates demonstrated a higher rate of failure compared to DC/LCDC plates (7.1% vs. 1.8%) (p<0.05). CONCLUSION: This study does not provide compelling evidence that either plate location is superior in terms of reducing rates of hardware removal or complications. Risk factors for failure of fixation include the use of reconstruction or 2.7 mm plates as opposed to lcdc or precontoured plates or 3.5 plates.
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