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

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