Dual Mini-Fragment Plate Fixation of Midshaft Clavicle Fractures Reduces Risk of Reoperation Compared With Single-Plate Fixation Techniques.

Autor:	Reddy RP; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Charles S; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Como M; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Chen SR; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Mittwede PN; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Rai A; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Moloney GB; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA., Sabzevari S; Department of Orthopaedics and Rehabilitation, Division of Sports Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Lin A; Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2023 Nov; Vol. 51 (13), pp. 3393-3400. Date of Electronic Publication: 2023 Oct 17.
DOI:	10.1177/03635465231203010
Abstrakt:	Background: Recent studies have highlighted dual plating as a method of reducing high rates of postoperative complication after operative management of displaced midshaft clavicular fractures. However, few studies have reliably characterized reoperation rates and magnitude of risk reduction achieved when using dual versus anterior and superior single-plate techniques. Hypothesis: There would be lower rates of reoperation among patients who underwent open reduction and internal fixation (ORIF) of displaced midshaft clavicular fractures via dual plating. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective analysis of patients who underwent ORIF for a displaced midshaft clavicular fracture between 2010 and 2021 at a level 1 trauma center with a minimum 12-month follow-up. Patients were separated into 3 cohorts based on fixation type: (1) orthogonal dual mini-fragment plate fixation, (2) superior plate fixation, and (3) anterior plate fixation. Data on patient characteristics, fracture pattern, and reoperations were documented. All-cause reoperation rates and hazard ratio (HR) estimates of dual, superior, and anterior plating were calculated using a multivariate multilevel mixed-effects parametric survival model. Significant confounders including high-risk fracture morphology and smoking status were controlled for in the final model. Results: A final cohort of 256 patients was identified with mean follow-up of 4.9 ± 3.8 years. In total, 101 patients underwent superior plating, 92 underwent anterior plating, and 63 underwent dual plating. Overall, 31 reoperations took place (18 in superior, 12 in anterior, 1 in dual plating) among 22 patients. Major contributors to reoperation included symptomatic hardware (n = 11), nonunion (n = 8), deep infection (n = 7), and wound dehiscence (n = 2). Superior plating revealed the highest reoperation rate of 0.031 per person-years, followed by anterior plating with 0.026 per person-years and dual plating with 0.005 per person-years. Overall, single plating (either anterior or superior placement) had a nearly 8-fold greater risk of reoperation than dual plating (HR, 7.62; 95% CI, 1.02-56.82; P = .048). Further broken down by technique, superior plating had an 8-fold greater risk of reoperation than dual plating (HR, 8.36; 95% CI, 1.10-63.86; P = .041), but anterior plating did not demonstrate a statistically significant difference compared with dual plating (HR, 6.79; 95% CI, 0.87-52.90; P = .068). Conclusion: Dual-plate fixation represents an excellent treatment for displaced midshaft clavicular fractures, with low rates of nonunion and reoperation. When compared with single locked superior or anterior plate fixation, dual mini-fragment plate fixation has a nearly 8-fold lower risk of reoperation. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: P.N.M. has received support for education from Mid-Atlantic Surgical Systems. G.B.M. has received compensation for serving as faculty or as a speaker for Synthes GmbH. A.L. has received consulting fees from Arthrex, Tornier, and Wright Medical Technology. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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