Barzilai University Medical Center

128 Research Day 2020 Barzilai University Medical Center 92 MECHANICAL FAILURE OF PLATE BREAKAGE AFTER OPEN REDUCTION AND PLATE FIXATION OF DISPLACED MIDSHAFT CLAVICLE FRACTURE - A POSSIBLE NEW RISK FACTOR: A CASE REPORT Batash R 1 , Debi R 1 , Grinberg D 1 , Shema M 1 , Elbaz A 2 , Benedict Y 1 . 1 Department of Orthopedics, Barzilai University Medical Center, Ashkelon, Israel. 2 AposTherapy Research Group, Herzliya, Israel. Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. Background Plate breakage is one form of construct failure after a clavicle fracture treated with an open reduction and plate fixation. A recent study evaluated construct failure after an open reduction and plate fixation and reported a construct failure rate of 6.9% of which 1.9% were related to broken plates. Plate breakage is rare, thus, there are insufficient data regarding risk factors, pathogenesis, or how to avoid it. Hypothesis Operative treatment using plates and screws fixation are the current gold standard in displaced and comminuted fractures. Objectives We present a scenario where the chain of decisions was in accordance to the patient’s goal (regain function as soon as possible) while considering other factors such as age, level of physical activity, and fracture pattern, yet the outcome was not satisfying. Results This case report presents an unusual case of a 35-year-old Caucasian man, 7 weeks after open reduction and internal plate fixation of a fracture in the middle third of his clavicle, who developed breakage of the implant. Surgery was advised, the implant was retrieved, the fracture was reduced, and a new bridging locking plate was implanted. Conclusions In the current case it seems that the use of a bridging plate, the fundamental anatomical structure of the clavicle and the forces that are applied on it, the lack of discipline in complying with the postoperative functional restrictions, and an unclear "patient expectation" process were the main reasons for the failure. These aspects should be carefully considered and addressed in clavicle fractures.