The following update provides a summary of selected studies related to orthopaedic trauma that were published mainly in 2015. Methods (→), results (◊), and take-home points (₪) are presented in an abridged fashion.
→ In a retrospective, single-center study that included 235 consecutive patients over a 9-year period who were treated with primary plate fixation (superior placement only) for a substantially displaced midshaft clavicular fracture with shortening and/or deformity, the authors evaluated 20 potential risk factors for reoperation related to implant removal or nonunion, infection, or fixation failure1.
◊ Among the 65% of patients who had 2-year follow-up, 38% (58) underwent reoperation.
₪ Intraoperative plate contouring and a patient height of <175 cm enhanced the risk of hardware removal (n = 42). Reoperation for nonunion, infection, or fixation failure (n = 16) was associated with illicit drug use, diabetes, and previous shoulder surgery. Multiple reoperations (n = 8) were related to an age of >55 years and alcohol use (>15 drinks per week); the presence of both factors led to a 78% reoperation risk.
→ In a prospective study, 76 consecutive Workers’ Compensation patients with displaced middle-third clavicular fractures were randomized to conservative treatment (n = 42) or surgical anatomic plate fixation (n = 34)2.
◊ Computed tomography (CT) scans at 6 and 12 weeks revealed advanced healing in the surgical treatment group: 24.1% at 6 weeks and 81% at 12 weeks versus 5.3% and 16.7%, respectively, in the conservative treatment group. The time from discharge to the return to full occupational duties was 3.7 ± 1.1 months in the conservative treatment group and 2.9 ± 0.8 months in the surgical treatment group. Four patients in the conservative treatment group experienced nonunion requiring surgery compared with no patient in the surgical treatment group. The reoperation rate …
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