Risk factors for clavicular midshaft fractures after hook plate fixation for the treatment of Neer type II clavicular fractures

Objective Neer type II fractures are common, and hook plate fixation is one of the recommended treatments. Although clavicular midshaft fractures after hook plate fixation are rare, such fractures increase patients’ suffering and worsen their functional outcomes. This study was performed to identify the risk factors for this complication. Methods From 2009 to 2018, 425 patients were admitted with Neer type II clavicular fractures. According to the selection criteria, 352 patients were included in this retrospective observational study. All patients were divided into either the complications group (patients with midshaft fractures) or the control group (patients without midshaft fractures). Data collected included patient demographics and surgical, hook plate, and screw characteristics. The chi-square test was used to conduct between-group comparisons of risk factors. Statistically significant variables were included in a logistic regression model. Results In both the complications group (n = 21) and control group (n = 331), significantly more patients of advanced age and significantly more patients treated with hook plates that were not bent during surgery developed midshaft fractures. Conclusion The risk of a clavicular midshaft fracture after hook plate fixation may be significantly increased by advanced age or a lack of hook plate bending.