Unplanned Operations and Adverse Events after Surgery for Diaphyseal Fracture of the Clavicle

Abstract

Background: We used a database of patients treated at three hospitals to study the primary null hypothesis that there<br />are no factors associated with unplanned reoperations or adverse events after surgical repair for diaphyseal clavicle<br />fracture. Additionally we addressed the following secondary study questions: 1. What is the prevalence of unplanned<br />reoperations or adverse events after surgical repair for diaphyseal clavicle fracture? 2. Is early implant loosening or<br />breakage after surgical repair for diaphyseal clavicle fracture related to fixation type? 3. Is the type of fixation associated<br />with the prevalence of brachial plexus palsy after surgical repair of a diaphyseal clavicle fracture?<br />Methods: We retrospectively analyzed 249 adult patients who had surgery for a diaphyseal clavicle fracture to<br />determine factors associated with unplanned reoperations or adverse events. Thirty-two patients (13%) had at least one<br />unplanned reoperation or adverse event. Four of 249 patients (1.6%) developed early implant loosening or breakage.<br />Patients that had local implant irritation, planned implant removal, or sensory symptoms thought to be due to nerve<br />irritation were not included in the reported unplanned reoperations or adverse event rate.<br />Results: Only female sex was associated with unplanned reoperations or adverse events after surgery for diaphyseal<br />clavicle fracture. No other patient, technical, or injury related factors tested in this study were associated with unplanned<br />reoperations or adverse events.<br />Conclusion: Patients that have surgery for diaphyseal clavicle fracture have an approximately 13% risk of an unplanned<br />second surgery or an adverse event. Women can be counseled that they are three times as likely as men to have an<br />unplanned reoperations or adverse event.<br />Level of evidence: III