Clavicle refractures after hardware removal – Are there risk factors? A retrospective cohort study

Introduction

Removal of symptomatic hardware after fracture fixation is common, especially in patients with clavicle fracture. Yet, several patients suffer a refracture after successful hardware removal. The aim of this study was to identify risk factors for clavicle refractures that could be influenced by the surgical treatment provided.

Material & Methods

All patients from a level one trauma center from 2017 to 2022 were screened for eligibility. Inclusion criteria included hardware removal after plate osteosynthesis of the clavicle, age ≥18 years, and signed informed consent. Groups were stratified according to occurrence of refracture: No-Refracture (NR) vs. Refracture (R). Nearest-neighbor matching in a ratio of 5:1 was performed. Parameter investigated included baseline demographics, fracture characteristics, surgical treatment details. A subgroup analysis of only clavicle shaft fractures was performed.

Results

Sixty patients were included with 50 patients in the NR and 10 in the R group. Baseline characteristics were comparable between the groups. The subgroup analysis on shaft fractures revealed that significantly more of free holes to the fracture sight (working-length) was present in the NR group (1.94±0.85) compared to the refracture group (1.20±0.92) (p=0.042). The logistic regression yielded an inverse correlation with the amount of free screw holes to the fracture sight and the occurrence of refractures (OR: 0.369, 95%CI: 0.132-0.873; p=0.035). Time in situ, lag screw application, plate positioning and the total amount of screws did not affect either of the groups.

Conclusions

An increased working length in patients with clavicle shaft fractures might be a protective measure for occurrence of refracture after hardware removal.

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