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Background <p>Locking plate fixation combined with coracoclavicular (CC) augmentation using a suspensory fixation system is a widely accepted technique for unstable lateral clavicle fractures. Elective hardware removal is commonly performed due to mechanical irritation or discomfort, yet data on radiographic and clinical outcomes following implant removal remain limited. The purpose of this study was to evaluate immediate radiographic loss of reduction and long-term clinical outcomes after removal of the locking plate and CC augmentation in patients with lateral clavicle fractures. It was hypothesized that a measurable loss of reduction occurs following hardware removal, and that clinical outcomes would nevertheless remain excellent, with no residual patient complaints.</p> Methods <p>A total of 41 patients with lateral clavicle fractures treated with locking plate fixation and CC augmentation underwent implant removal between 2013 and 2022. Coracoclavicular distance (CCD) was measured pre- and immediately post-removal. Clavicular drill tunnel (CDT) diameters were measured post-removal. Clinical outcomes were assessed using PROMs (CMS, DASH, SPADI, SSV, VAS), as well as return to work and sports, and re-operation rates.</p> Results <p>The mean CCD increased from 9.1 ± 3.2&#xa0;mm to 10.0 ± 3.0&#xa0;mm after implant removal (<i>p</i> &lt; .0001). A loss of reduction ≥ 10% was observed in 54% of cases, and a substantial loss (≥ 6&#xa0;mm) in 12%. CDT measurements showed significant tunnel widening toward the inferior cortex compared to the superior and mid-clavicular cortex (<i>p</i> &lt; .0001). Clinically, 23 patients were included after a mean follow-up of 71 months. Patients achieved excellent outcomes with a mean CMS of 88.5 ± 10.5, DASH of 5.4 ± 7.6, SPADI of 93.4 ± 7.9, SSV of 95.4 ± 6.9, and VAS of 0.6 ± 1.1. PROMs did not differ between patients with or without radiographic loss of reduction. All patients returned to work and sports, with no reoperations required.</p> Conclusions <p>Although 54% of patients showed a measurable radiographic loss of reduction following implant removal, substantial displacement was uncommon (12%). Radiographic loss of reduction was not associated with inferior clinical outcomes. Patients demonstrated excellent long-term function, with a full return to work and sports.</p>

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Immediate radiographic reduction loss but preserved clinical outcomes after hardware removal in lateral clavicle fractures treated with plate fixation and coracoclavicular augmentation

  • 期刊论文

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  • 发表日期：

    2026年3月17日

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  • Malik Jessen,
  • Lennart Gerdesmeyer,
  • Philipp Zehnder,
  • Michael Zyskowski,
  • Peter Biberthaler,
  • Chlodwig Kirchhoff,
  • Markus Schwarz

摘要

Background

Locking plate fixation combined with coracoclavicular (CC) augmentation using a suspensory fixation system is a widely accepted technique for unstable lateral clavicle fractures. Elective hardware removal is commonly performed due to mechanical irritation or discomfort, yet data on radiographic and clinical outcomes following implant removal remain limited. The purpose of this study was to evaluate immediate radiographic loss of reduction and long-term clinical outcomes after removal of the locking plate and CC augmentation in patients with lateral clavicle fractures. It was hypothesized that a measurable loss of reduction occurs following hardware removal, and that clinical outcomes would nevertheless remain excellent, with no residual patient complaints.

Methods

A total of 41 patients with lateral clavicle fractures treated with locking plate fixation and CC augmentation underwent implant removal between 2013 and 2022. Coracoclavicular distance (CCD) was measured pre- and immediately post-removal. Clavicular drill tunnel (CDT) diameters were measured post-removal. Clinical outcomes were assessed using PROMs (CMS, DASH, SPADI, SSV, VAS), as well as return to work and sports, and re-operation rates.

Results

The mean CCD increased from 9.1 ± 3.2 mm to 10.0 ± 3.0 mm after implant removal (p < .0001). A loss of reduction ≥ 10% was observed in 54% of cases, and a substantial loss (≥ 6 mm) in 12%. CDT measurements showed significant tunnel widening toward the inferior cortex compared to the superior and mid-clavicular cortex (p < .0001). Clinically, 23 patients were included after a mean follow-up of 71 months. Patients achieved excellent outcomes with a mean CMS of 88.5 ± 10.5, DASH of 5.4 ± 7.6, SPADI of 93.4 ± 7.9, SSV of 95.4 ± 6.9, and VAS of 0.6 ± 1.1. PROMs did not differ between patients with or without radiographic loss of reduction. All patients returned to work and sports, with no reoperations required.

Conclusions

Although 54% of patients showed a measurable radiographic loss of reduction following implant removal, substantial displacement was uncommon (12%). Radiographic loss of reduction was not associated with inferior clinical outcomes. Patients demonstrated excellent long-term function, with a full return to work and sports.