Refracture after implant removal of the clavicle: a retrospective cohort analysis

This retrospective single-center study followed 575 adults who had clavicle plates removed after confirmed fracture healing and asked how often the bone rebroke afterward. Refracture occurred in 21 patients (3.7%), most within the first two years and typically after a new trauma at the original fracture site; the only significant risk factor identified was complex, comminuted midshaft fracture morphology (AO type 15.2C), which carried roughly a 6.7-fold higher hazard of refracture than other fracture types. Age, sex, BMI, smoking, ASA class, and how long the implant stayed in before removal were not associated with refracture risk.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersRefracture is an uncommon but recognized complication of elective clavicle hardware removal, and this is the largest cohort to date suggesting fracture morphology, not implant retention time, should guide the decision to remove plates.

Presenting this at rounds? Start here

• ?With only 21 refracture events driving the multivariable Cox model, and the authors themselves flagging overfitting risk and wide confidence intervals (HR 6.70, 95% CI 1.49-30.12), how much weight should be placed on AO 15.2C as an independent predictor?
• ?If a patient with a healed AO 15.2C midshaft clavicle fracture requests implant removal purely for cosmetic or mild discomfort reasons, how should this refracture risk data change your counseling and shared decision-making?