Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2022 Jan;142(1):139-144.
doi: 10.1007/s00402-020-03669-z. Epub 2020 Nov 1.

Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial

Markus Wurm  1 , Marc Beirer  1 , Michael Zyskowski  1 , Christopher Völk  1 , Arthur Schwarz  1 , Peter Biberthaler  1 , Chlodwig Kirchhoff #  2 , Moritz Crönlein #  1
Affiliations
Clinical Trial

Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial

Markus Wurm et al. Arch Orthop Trauma Surg. 2022 Jan.

Abstract

Background: Elective implant removal (IR) accounts for up to 30% of all orthopaedic surgeries. While there is general acceptance about the need of implant removal for obvious reasons, such as infections or implant failure, little is known about the beneficial aspects in cases of minor reasons such as patients' wish for IR. Therefore, we initiated this study to define patients' benefit of elective implant removal following plate osteosynthesis of displaced clavicle fractures.

Patients and methods: Prospective evaluation of patients was conducted before implant removal and 6 weeks postoperative. Subjective and objective criteria included pain rating on a visual analogue scale (VAS) and active range of motion (ROM) pre- and 6 weeks postoperative. Functional scoring included Constant-Murley Score, DASH (Disabilities of Arm, Shoulder and Hand Score), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index).

Results: 37 patients were prospectively enrolled in this study and implant removal was performed after 16 ± 6.1 months. No re-fractures nor other complications were detected during routine follow up. Functional outcome increased through all scores (Constant score 73.3 ± 14.6 preoperative to 87.4 ± 12.0 postoperative (p = 0.000), MSQ 85.0 ± 7.3 preoperative to 91.8 ± 9.0 postoperative (p = 0.005), DASH Score 7.4 ± 8.2 preoperative to 5.7 ± 9.5 postoperative (p = 0.414), SPADI 93.4 ± 6.6 preoperative to 94.0 ± 10.1 postoperative (p = 0.734).

Conclusions: Discomfort during daily activities or performing sports as well as limited range of motion were the main reasons for patients' wish for implant removal. We found increased functional outcome parameters and decreased irritation after implant removal. Therefore we suggest implant removal in case of patients' wish and completed fracture consolidation.

Trial registration: Trial registration no: NCT04343118, Retrospective registered: www.clinicaltrials.gov .

Keywords: Clavicle fractures; Disturbing implants; Elective surgery; Hardware removal; Implant removal; Irritation.

PubMed Disclaimer

Conflict of interest statement

All authors declare no competing interests with respect to the nature of this article.

Figures

Fig. 1
Fig. 1
Midshaft clavicle fracture (OTA 15.C2) preoperative (a), after osteosynthesis using a preformed distal end clavicle plate (Arthrex ®) (b) and after implant removal with remaining 2.0 mm cortical screw (c)
See this image and copyright information in PMC

References

    1. Huttunen TT, Launonen AP, Berg HE, Lepola V, Fellander-Tsai L, Mattila VM. Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001–2012. J Bone Joint Surg Am. 2016;98:1837–1842. doi: 10.2106/JBJS.15.01284. - DOI - PubMed
    1. Fuglesang HFS, Flugsrud GB, Randsborg PH, Oord P, Benth JS, Utvag SE. Plate fixation versus intramedullary nailing of completely displaced midshaft fractures of the clavicle: a prospective randomised controlled trial. Bone Joint J. 2017;99-B:1095–1101. doi: 10.1302/0301-620X.99B8.BJJ-2016-1318.R1. - DOI - PubMed
    1. Zehir S, Zehir R, Sahin E, Calbiyik M. Comparison of novel intramedullary nailing with mini-invasive plating in surgical fixation of displaced midshaft clavicle fractures. Arch Orthop Trauma Surg. 2015;135:339–344. doi: 10.1007/s00402-014-2142-1. - DOI - PubMed
    1. Beirer M, Banke IJ, Harrasser N, Cronlein M, Pforringer D, Huber-Wagner S, et al. Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft. BMC Musculoskelet Disord. 2017;18:129. doi: 10.1186/s12891-017-1488-2. - DOI - PMC - PubMed
    1. Beirer M, Siebenlist S, Crönlein M, Postl L, Huber-Wagner S, Biberthaler B, et al. Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension. BMC Musculoskelet Disord. 2014;15:380. doi: 10.1186/1471-2474-15-380. - DOI - PMC - PubMed

Publication types

Associated data