BACKGROUND Open reduction and internal fixation (ORIF) with plates and screws is one of the treatment options for clavicle fractures. However, an additional operation for implant removal after union of the fracture is commonly performed due to a high incidence of hardware irritation. Despite union of the fracture, a subsequent refracture might occur after removal of the implant which requires additional surgeries for fixation. This study aims to determine the risk factors associated with refracture of the clavicle after hardware removal. METHODS We retrospectively reviewed the medical records of 278 patients that were diagnosed with a midshaft clavicle fracture (male 190; female 88) that had (1) undergone ORIF of the clavicle with plates and (2) received a second operation for removal of hardware after solid union of the fracture between 2010 and 2017. Their mean age was 40.1 ± 15.1 years, and mean interval from fixation to plate removal was 12.5 ± 7.5 months. The patients were then divided into two groups based on the presence of refracture (n = 20) or without refracture (n = 258). We analyzed patient demographics, interval between fixation and implant removal, fracture classification (AO/OTA, Robinson), fixation device, whether wires or interfragmentary screws were used, clavicular length, and bone diameter at the fracture site. RESULTS The overall refracture rate was 7.2%, and the mean interval between plate removal and refracture was 23.9 days. A multivariate analysis showed that female (adjusted odds ratio [aOR] 4.74; 95% CI 1.6-14.1) and body mass index [BMI] (for every 1-unit decrease, aOR 1.25; 95% CI 1.06-1.48) were risk factors for refracture. In women, BMI was the only risk factor. The optimal BMI cutoff value was 22.73. In a female patient with a lower BMI, the refracture rate was 29.8%. CONCLUSIONS There are no significant radiographic parameters associated with refracture. Routine plate removal in a female patient with a low BMI after bony union of a midshaft clavicle fracture is not recommended because of a high refracture rate.

中文翻译：

---

骨联合后中轴锁骨骨折，取下钢板后发生再骨折的危险因素。

背景技术用钢板和螺钉进行的切开复位内固定（ORIF）是锁骨骨折的治疗选择之一。但是，由于硬件刺激的发生率很高，通常在骨折合并后执行用于去除植入物的附加操作。尽管骨折合并，但在移除植入物后可能会发生随后的骨折，这需要额外的手术进行固定。这项研究的目的是确定与硬件切除后锁骨骨折相关的危险因素。方法我们回顾性分析了278例诊断为锁骨中段中枢骨折的患者的病历（男190例；男190例）。女性（88岁）在2010年至2017年间接受牢固的骨折合并手术后，（1）接受了带板锁骨的ORIF手术，（2）接受了第二次手术以去除硬件。他们的平均年龄为40.1±15.1岁，平均间隔从固定到取板的时间为12.5±7.5个月。然后根据是否存在屈光（n = 20）或不存在屈光（n = 258）将患者分为两组。我们分析了患者的人口统计资料，固定和植入物去除之间的间隔，骨折分类（AO / OTA，Robinson），固定装置，是否使用了金属丝或碎片间螺钉，锁骨长度和骨折部位的骨直径。结果总折返率为7.2％，取板与折返之间的平均间隔为23.9天。多元分析表明，女性（风险比调整后比值[aOR] 4.74； 95％CI 1.6-14.1）和体重指数[BMI]（每降低1个单位，aOR 1.25； 95％CI 1.06-1.48）是危险因素进行屈光手术。在女性中，BMI是唯一的危险因素。最佳BMI截止值为22.73。在女性患者中，BMI较低，其屈曲率为29.8％。结论没有明显的影像学参数与屈光有关。不建议女性患者中骨锁骨中段骨折骨连接后常规行BMI低的手术，因为其高折断率。在女性患者中，BMI较低，其屈曲率为29.8％。结论没有明显的影像学参数与屈光有关。不建议女性患者中骨锁骨中段骨折骨性结合后常规行BMI低的常规手术，因为其折返率较高。在女性患者中，BMI较低，其屈曲率为29.8％。结论没有明显的影像学参数与屈光有关。不建议女性患者中骨锁骨中段骨折骨性结合后常规行BMI低的常规手术，因为其折返率较高。