Poster 179: Fracture Morphology,Surgical Technique,and Obesity as Predictors of Major Postoperative Complications in Midshaft Clavicle Fractures

Abstract

Objectives:

Optimal management of midshaft clavicle fractures remains controversial. This study assessed demographic factors, injury patterns, and surgical technique as potential predictors of complications following open reduction internal fixation (ORIF) of midshaft clavicle fractures. We hypothesize that smoking, diabetes, obesity, and fracture pattern would be risks factors for surgical complications.

Methods:

Consecutive patients who presented to a single tertiary institution who underwent ORIF of midshaft clavicle fractures were identified retrospectively from 2007-2019. Patients who were lost to follow-up or had a follow-up period of 12 weeks or less, were excluded from analyses. Of the 354 eligible patients, 223 (63%) completed at least 12 weeks of follow-up.

Demographics, injury data, surgery characteristics, and postoperative complications were recorded. Postoperative complications were obtained via chart review and separated into major (reoperation) and minor (no reoperation) complications based on reoperation status. Chi-squared statistics, Fisher’s Exact test, and multivariate logistic regression were utilized with significance level set to p<0.05.

Results:

223 patients (average 39.3 + 15.2 yo) were identified with average follow-up of 9.2 months Table 1. Overall complication incidence was 21.5% (95% [CI], 16.3% to 27.5%), minor complication incidence was 15.2% (95% [CI], 10.8% to 20.6%), major complication incidence was 6.3% (95% [CI], 3.5% to 10.3%), and incidence of non-union was 1.8% (95% [CI], 0.5% to 4.5%). Major complications requiring reoperation revealed 4 cases of non-union (28.6%), 4 instances of symptomatic hardware (28.6%), 3 incidents of deep infections (21.4%), 1 instance of acromioclavicular joint dislocation (7.1%), and 1 incident of broken hardware (7.1%).

Smoking status, obesity, and fracture morphology were significant prognostic factors for overall complication risk while diabetes was not. Results from a multivariate analysis demonstrated a 2.4- and 3.2-times greater risk of overall post-operative complications among smokers and obese patients, respectively (p=0.013 and p=0.004, respectively). After adjusting for BMI and smoking status, the risk of post-operative complications among patients with a transverse fracture was 2.26 times greater compared to a patient with an oblique fracture (p = 0.035).

Regarding major complications, obese patients were 3.5-times more likely to require reoperative intervention. Moreover, after adjusting for obesity status, transverse and z-type fractures had an 8.9- and 22.7-times greater risk for reoperation, relative to patients with oblique fractures respectively (p=0.04 and p=0.006, respectively. Finally, there were no reported major complications among patients with dual plating, and nonunion occurred exclusively among patients with transverse fractures.

Conclusions:

Fracture pattern, obesity, and smoking status were significant predictors of postoperative complications. However, only fracture morphology, BMI, and surgical technique were significant predictors of reoperative risk. Transverse and z-type fractures may require increased vigilance, especially among obese patients, with potential consideration for dual plating in these circumstances.

Table 1.

Baseline Characteristics