Emile OliverMedway Maritime Hospital, United Kingdom
Title: Outcomes of clavicle fixation: Results from a District General Hospital
Historically, clavicular fractures were almost universally treated non-operatively. Although fixation techniques have evolved significantly over the recent decades, the most appropriate management of these fractures is still heavily debated. The aim of this study was to look at the patient outcomes and complications of surgically fixed clavicle fractures at a district general hospital, operated over a period of 8 years.
Patients were retrospectively identified through the hospital database from 2011 to 2019. Inclusion criteria were skeletally mature patients who underwent operative fixation for both acute, delayed and non-unions. Data was collected regarding demography, smoking status, mechanism of injury, indications for surgery, complications of operative fixation including non-union, infection and rates of metalwork removal. Patients were also contacted to calculate quickDASH scores.
191 patients were identified, including 151 midshaft, 37 lateral and 3 medial fractures. Mean time to surgery was 68 days (17 for acute fractures, 117 for delayed union and 409 days for non-union). We were able to contact 84 patients at a mean follow up of 4.1 years. Their mean quickDASH score was 6.9 (5.5 for acute fixations and 14.6 for non-unions). The overall complication rate was 17.8% (1% non-union rate, 2.6% infection rate and 7.8% plate removal rate, excluding hook plates).
This study is currently the largest in the literature looking at outcomes of surgical fixation of clavicle fractures. We have demonstrated operative management results in excellent long-term outcomes in terms of patient-rated satisfaction outcomes and low non-union rates. As with all surgery, it is not without its complications. If surgery can be avoided, it should be. In patients at high risk of non-union or if signs of non-union are recognized early on, we suggest considering earlier fixation to improve long term patient satisfaction rates.
Emile Oliver completed a bachelor’s degree in Mechanical Engineering at the University of Bristol prior to studying medicine at Barts and The London. He is currently a specialist registrar in Trauma and Orthopaedic Surgery the Kent, Surrey and Sussex deanery in the United Kingdom.