The incidence of hardware removal (HWR) after operative fixation of clavicle fractures varies widely. Risk factors related to HWR remain incompletely understood. The aim of this study was to evaluate the incidence and risk factors for HWR after plate fixation of middle and distal third clavicle fractures. We hypothesized: 1) total HWR incidence would be less than 20 percent, 2) HWR incidence of operative distal and middle third clavicle fractures would not be statistically different, and 3) symptomatic implants would be the most common HWR indication.
A multi-hospital retrospective study was performed of skeletally-mature patients who underwent plate fixation of middle and distal third clavicle fractures from November 2008 to November 2018. Data included patient demographics, mechanism of injury, operative records, hardware-related symptoms, subsequent HWR, and complications.
One hundred and three patients (age 16-75, 76.7% male) were included. Eighty-seven (84.5%) patients had plate fixation for mid-shaft clavicle fractures and 16 (15.5%) for distal third clavicle fractures. Thirteen patients (12.6%) underwent HWR. A significantly higher percentage of HWR procedures were performed for distal clavicle fractures (50%) as compared to middle third (4.9%, p < 0.0001). An initial high-energy mechanism of injury was associated with HWR (p = 0.0025). The most common indication for HWR was symptomatic hardware (69.2%). The overall complication rate was 14.5%.
The overall incidence of clavicle HWR was 12.6%. Distal fracture location was associated with a significantly higher incidence of hardware removal. Initial high energy mechanism of injury was a significant risk factor for HWR. The primary indication for HWR was symptomatic hardware.

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