Open reduction internal fixation of midshaft clavicle fractures augmented with autogenous bone graft versus bioresorbable calcium phosphate: a com parative study

Background Recent studies have demonstrated that nonoperative treatment of displaced midshaft clavicle fractures have a high prevalence of symptomatic malunion and nonunion with nonoperative treatment [Hill et al. J Bone Joint Surg Br 79: 537–539, 1997; Mckee et al. J Trauma 47: 616, 2001; Simon Eur J Orthop Surg Traumatol 20: 521–525, 2010]. Although good results have been demonstrated with open reduction internal fixation (ORIF), complications still exist thus fixation was augmented. This retrospective study was undertaken to determine the efficacy of open reduction and internal fixation (ORIF) augmented with bioresorbable calcium phosphate (BCP) cement compared with standard autogenous bone grafting (ABG) of acute displaced, midshaft clavicle fractures. Methods At our level I trauma institute, from July, 2007 to September 2008, each patient who presented with a clavicle fracture that was deemed operative received plate fixation supplemented with bioresorbable calcium phosphate cement or autogenous bone grafting. Patient records and radiographs were retrospectively reviewed. Follow-up included standard radiographs to evaluate union at a minimum of 6 months. All complications were also reviewed. Results Two different clavicle plating systems, Smith and Nephew (Smith and Nephew, Memphis, USA) (18 clavicles) and Implant Technology Systems (I.T.S., Lassnitzhohe, Austria) (24 clavicles), were used with autogenous bone graft (14 patients) or bioabsorbable calcium phosphate (28 clavicles). Of forty patients treated with open reduction internal fixation, 6 complications have occurred at a minimum of 6-month follow-up. Three prominent hardware occurrences necessitated plate removal. One nonunion, one distal screw cutout, and one hardware breakage have been treated successfully with revision plating. Using Fisher’s exact test, no statistical significance was seen between the autogenous bone grafting (2) and bioabsorbable calcium phosphate (4) in regard to overall failure incidence (P = 0.66). Complications necessitating revision ORIF with bioabsorbable calcium phosphate (2) and bone graft (1) were not statistically significant either (P = 0.73). Conclusion There appears to be no statistically significant difference between union and complication rates between bioresorbable calcium phosphate cement and autogenous bone graft in this retrospective study.