Abstract
BackgroundPlate breakage is one form of construct failure after a clavicle fracture treated with an open reduction and plate fixation. A recent study evaluated construct failure after an open reduction and plate fixation and reported a construct failure rate of 6.9% of which 1.9% were related to broken plates. Plate breakage is rare, thus, there are insufficient data regarding risk factors, pathogenesis, or how to avoid it.Case presentationThis case report presents an unusual case of a 35-year-old Caucasian man, 7 weeks after open reduction and internal plate fixation of a fracture in the middle third of his clavicle, who developed breakage of the implant. Surgery was advised, the implant was retrieved, the fracture was reduced, and a new bridging locking plate was implanted.ConclusionsIn the current case it seems that the use of a bridging plate, the fundamental anatomical structure of the clavicle and the forces that are applied on it, the lack of discipline in complying with the postoperative functional restrictions, and an unclear “patient expectation” process were the main reasons for the failure. These aspects should be carefully considered and addressed in clavicle fractures.
Highlights
ConclusionsIn the current case it seems that the use of a bridging plate, the fundamental anatomical structure of the clavicle and the forces that are applied on it, the lack of discipline in complying with the postoperative functional restrictions, and an unclear “patient expectation” process were the main reasons for the failure
Plate breakage is one form of construct failure after a clavicle fracture treated with an open reduction and plate fixation
A recent study evaluated construct failure after an open reduction and plate fixation and reported a construct failure rate of 6.9% of which 1.9% were related to broken plates [7]
Summary
This case study presents a rare plate failure expressed as plate breakage. We believe the main reasons for the plate breakage were the type of fracture requiring a bridging plate, the nature of forces and loads on the bone, and lack of setting up clear patient expectations. Future studies should consider the anatomy of the clavicle and think of new ways to accelerate bone growth by applying forces through the bone and not perpendicular to it. It may be assumed that the notion that setting up patient expectations is an important process for good surgical outcome applies to patients with a displaced midshaft clavicle fracture
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