Authors: Scott F.M. Duncan, MD, MPH; John W. Sperling, MD; Scott P. Steinmann, MD
Title: Treatment and Outcome of Infected Clavicle Fractures
Addresses: Dept of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905.
Purpose: Currently, there are no reported series on the outcome of patients treated for infection after clavicle fractures. Therefore, the purpose of this study, was to review patients who were treated for infection after clavicle fractures at our institution between 1995 and 2001 to determine the functional outcome and organisms responsible for infection
Methods: Between 1995 and 2001, all patients who were treated for clavicular infection were reviewed. Patients were identified with use of a computerized patient registry. During this period, six patients were treated for infection after sustaining a clavicular fracture. Five patients had a postoperative infection after attempts at open reduction and internal fixation. One patient had an infection after her non-union eroded through the skin. The man age was 45 years old (range, 17-65 years). The mean number of procedures performed was 3.7 (range, 3-5).
Results :Only two of five fractures healed at most recent follow-up. Three patients were infected by Prop. Acnes, two by MSRA, and one MRSE. The mean length of antibiotic treatment was 8 weeks. Both patients whose fractures healed had no pain over the clavicle. The length of time to heal the fracture was 3 months and 23 months. Each of the three patients with a nonunion continued to have pain.
Discussion: Infection may be acute or significantly delayed from the time of the initial surgical procedure. Among those with continued nonunions despite surgical intervention, late infection should be suspected. In this series, only two of the infected clavicles went on to union.
Significance: The surgeon should be aware of the extreme difficulty in treating this complication and poor prognosis for bone healing.