Jin Tatt GAN, Sankara Kumar CHANDRASEKARAN, Tuan Basyirudin Tuan JUSOH

Clinical outcome and operative cost comparison: Locked compression plate versus reconstruction plate in midshaft clavicle fractures

Objective: The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture.Methods: From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration.Results: The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p

___

1. Stegeman SA, de Jong M, Sier CF, et al. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicenter randomised controlled trial. BMC Musculoskelet Disord 2011; 12: 196. doi: 10.1186/1471-2474-12-196. [Crossref]

2. Neer CS. Nonunion of the clavicle. J Am Med Assoc 1960; 172: 1006-11. [Crossref]

3. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fracture. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007; 89: 1-10. [Crossref]

4. Althausen PL, Shannon S, Lu M, et al. Clinical and financial comparison of operative and nonoperative treatment of displaced clavicle fractures. J Shoulder Elbow Surg 2013; 22: 608-11. [Crossref]

5. Van Olden GD. VA-LCP anterior clavicle plate: The anatomical precontoured fixation system with angular stability for clavicle shaft fracture. Musculoskelet Surg 2014; 98: 217-23. [Crossref]

6. Chu CM, Wang SJ, Lin LC. Fixation of mid-third clavicular fractures with Knowles pin: 78 patients followed for 2-7 years. Acta Orthop Scand 2002; 73: 134-9. [Crossref]

7. Chuang TY, Ho WP, Hsieh PH, Lee PC, Chen CH, Chen YJ. Closed reduction and internal fixation of acute midshaft clavicular fractures using cannulated screws. J Trauma 2006; 60: 1315-20. [Crossref]

8. Lee YS, Lin CC, Huang CR, Chen CN, Liao WY. Operative treatment of midclavicular fractures in 62 elderly patients: Knowles pin versus plate. Orthopaedics 2007; 30: 959-64. [Crossref]

9. VanBeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Precountered plating of clavicle fractures. Decreased hardware related complications. Clin Orthop Relat Res 2011; 469: 3337-43. [Crossref]

10. Wijdicks FJG, Van der Meijden OA, Millett PJ, Verleisdonk EJMM, Houwert RM. Systemic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012; 132: 617-25. [Crossref]

11. Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Operative treatment of clavicle midshaft fractures: Comparison between reconstruction plate and reconstruction locking compression plate. Clin Orthop Surg 2010; 2: 154-9. [Crossref]

12. Lai YC, Tarng YW, Hsu CJ, Chang WN, Yang SW, Renn JH. Comparison of dynamic and locked plates for treating midshaft clavicle fractures. Orthopaedics 2012; 35: 697-702. [Crossref]

13. Meeuwis MA, Pull Ter Gunne AF, Verhofstad MHJ, van der Heijden FHWM. Construct failure after open reduction and plate fixation of displaced midshaft clavicular fractures. Injury 2017; 48: 715-9. [Crossref]

14. Gilde AK, Jones CB, Sietsema DL, Hoffmann MF. Does plate type influence the clinical outcomes and implant removal rate in midclavicular fractures fixed with 2.7-mm anteroinferior plates? A retrospective cohort study. J Orthop Surg Res 2014; 9: 55. doi: 10.1186/s13018-014-0055-x. [Crossref]

15. Rawlings M, Knox D, Patel M, Ackland D. A hybrid approach to mid-shaft clavicle fixation. Injury 2016; 47: 893-8. [Crossref]

16. Croley JS, Morris RP, Amin A, Lindsey RW, Gugala Z. Biomechanical comparison of bicortical, unicortical and unicortical far-cortex-abutting screw fixations in plated comminuted midshaft clavicle fractures. J Hand Surg Am 2016; 41: 703-11. [Crossref]

17. Looft JM, Corrêa L, Patel M, Rawlings M, Ackland DC. Unicortical and bicortical plating in the fixation of comminuted fractures of the clavicle: A biomechanical study. ANZ J Surg 2017; 87: 915-20. [Crossref]

18. Saidapur SK, Khadabadi NA. Locking plate fixation of mid-shaft clavicle fracture: Analysis of complications, reoperation rates and functional outcome. Int J Orthop Sci 2017; 3: 1071-3. [Crossref]

19. Fridberg M, Ban I, Issa Z, Krasheninnikoff M, Troelsen A. Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases. Int Orthop 2013; 37: 689-92. [Crossref]

20. Qiu XS, Wang XB, Zhang Y, Zhu YC, Guo X, Chen YX. Anatomical study of the clavicles in a Chinese population. Biomed Res Int 2016; doi: 10.1155/2016/6219761. Epub 2016 Mar 21. [Crossref]