Midshaft clavicle fracture following osteosynthesis with a hook plate for the treatment of Neer type Ⅱ distal clavicle fractures:a retrospective study
Objective To discover the risk factors for the midshaft clavicle fracture at the medial end of the hook plate following internal fixation for Neer type Ⅱ distal clavicle fractures and to suggest preventive surgical techniques.Methods Between February 2010 and January 2022,a total of 385 patients were diagnosed with Neer type Ⅱ distal clavicular fractures and treated with hook plates at our trauma center.All patients were divided into either the complication group(group Ⅰ,patients with midshaft fractures,n=17)or the control group(group Ⅱ,patients without midshaft fractures,n=368).Data collected included patient demographics,type of medial screw,plate or hook bending during the surgery,the number of holes in the plate,and hook plate depth.The Chi-square test was used to conduct between-group comparisons of these variables.Statistically significant variables were included in a multivariate logistic regression analysis to identify independent risk factors for midshaft clavicle fractures following hook plate fixation for distal clavicle fractures.Results Compared to the control group,there were significantly more elderly patients(12.5%vs.41.2%,P=0.001)and significantly more patients treated with hook plates that were not bent during surgery(44.0%vs.82.4%,P=0.004)in the complication group.The differences were statistically significant.Based on the multivariate logistic regression analysis,elderly patients were more likely to experience clavicular midshaft fractures(unadjusted OR,4.900;P=0.002;adjusted OR,4.041;P=0.008).Patients treated with hook plates that were not bent during surgery were more likely to experience midshaft fractures(unadjusted OR,5.934;P=0.006;adjusted OR,5.176;P=0.012).Conclusions The incidence of midshaft clavicle fractures following osteosynthesis with a clavicle hook plate for the treatment of distal clavicle fractures is not negligible,especially in elderly patients and patients treated with hook plates that are not bent during surgery.Therefore,the two variables are independent risk factors for clavicular midshaft fractures.Awareness of this complication and its risk factors reminds us to avoid such complication with caution.
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