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Midshaft clavicle fracture following osteosynthesis with a hook plate: a retrospective case analysis

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The clavicle hook plate has been commonly used to treat distal clavicle fractures and acromioclavicular (AC) joint dislocations; however, midshaft clavicle fracture at the medial end of the hook plate remains an underestimated complication. We aimed to discover the risk factors for this complication and the influence of these risk factors on patients and to suggest preventive surgical techniques.

Methods

We retrospectively reviewed the records of 150 patients with acute distal clavicle fractures or acute AC joint dislocations treated by internal fixation with a clavicle hook plate. The patient demographics, the occurrence of midshaft clavicle fracture at the medial end of the hook plate, and functional outcomes were analyzed. The functional outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) Shoulder Score and grading of the Constant shoulder score after the hook plate was removed.

Results

In total, 17 patients had complicating midshaft clavicle fractures at the medial end of the hook plate. Elderly patients had a higher risk of developing this complication than young patients. The odds ratio was 4.4 (p < 0.05). The average ASES score and grading of Constant score of these patients were 74.1 and 16.3 points, respectively, which were significantly inferior to those of patients without complications (p < 0.001).

Conclusion

The incidence of midshaft clavicle fractures following osteosynthesis with a clavicle hook plate was not negligible, especially in elderly patients. This complication may impair shoulder function and quality of life. Awareness of this complication and the risk factors for this complication reminds us to perform such operations with caution.

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Acknowledgments

We would like to thank American Journal Experts (www.aje.com) for providing English language editing.

Funding

The authors have not received grant support or research funding, and the authors do not have any proprietary interests in the materials described in the article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tri-Service General Hospital and National Defense Medical Center, No. 325, Cheng-gong Road Section 2, Taipei, 11472, Taiwan, Republic of China

    Jen-Ta Shih, Chia-Chun Wu, Chih-Chien Wang, Tsu-Te Yeh, Ru-Yu Pan & Pei-Hung Shen

  2. Department of Orthopaedic Surgery, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan, Republic of China

    Chien-Lung Chen

  3. School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Wu-Chien Chien

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  1. Jen-Ta Shih
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  2. Chia-Chun Wu
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Contributions

Conceptualization: P-HS & C-CW; methodology: C-CW; formal analysis and investigation: C-LC & W-CC; writing—original draft preparation: J-TS; writing—review and editing: T-TY & R-YP; supervision: P-HS; all authors have read and approved the final manuscript.

Corresponding author

Correspondence to Pei-Hung Shen.

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Conflict of interest

Jen-Ta Shih, Chia-Chun Wu, Chih-Chien Wang, Tsu-Te Yeh, Ru-Yu Pan, Chien-Lung Chen, Wu-Chien Chien, and Pei-Hung Shen declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board of Tri-Service General Hospital, National Defense Medical Center (Approval Number: 1-108-05-041). All procedures were performed in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all eligible participants.

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Shih, JT., Wu, CC., Wang, CC. et al. Midshaft clavicle fracture following osteosynthesis with a hook plate: a retrospective case analysis. Arch Orthop Trauma Surg 140, 1713–1718 (2020). https://doi.org/10.1007/s00402-020-03397-4

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  • DOI: https://doi.org/10.1007/s00402-020-03397-4

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