ORIF is the Gold Standard: Stop Guessing and Plate it! Michael D. - PowerPoint PPT Presentation

ORIF is the Gold Standard: Stop Guessing and Plate it! Michael D. McKee, MD, FRCS(C) • Professor and Chair, Department of Orthopaedic Surgery • University of Arizona, College of Medicine, Phoenix, AZ •

Disclosure • Studies supported by: - OTA, COA, ASES - Zimmer Inc. - Stryker, Olympus Biotech, AO • I am a consultant for Stryker, Acumed, Zimmer, ITS • Receive royalties from Stryker (plates), LWW, Springer (publishers)

1994 • We will give you a sling and everything should be fine.

Clavicle nonunion

Nonunion Robinson 2014 1 94 36 98 54.5% 0.21 (0.01, 0.75) Ahrens 2017 1 131 16 123 24.4% 0.09 (0.01,0.62)

RCT : Nonunion Study Plate fixation Non-operative COTS n = 132 1% 18% Robinson n = 202 1% 28% Ahrens n = 302 1% 15%

Nail versus Plate RCT • Plate fixation versus intramedullary nailing of completely displaced midshaft fractures of the clavicle: a prospective RCT • Fuglesang HFS et. al. BJJ 2017 • 123 patients, generally good results • Plate better early, IM nail less infection, OR time

Fixing a Clavicle Fracture is a Finesse Operation With a Narrow Risk-Benefit Ratio

Surgical Risk-Benefit Ratio • Life saving • Improves U/E function • Non-op Rx bad • Non-op Rx ok • Indestructible • Can fall apart • Reconstruction • Reconstruction difficult reasonable • Ratio: ++++ • Ratio: +

Conclusions - displaced midshaft fracture of the clavicle • With non-op care, nonunion risk is approximately 15%-20% • The nonunion rate following ORIF is 1-2 % • ORIF provides more rapid return to function / activity • ORIF is superior to non-operative care in select cases • Most patients do well with non-operative treatment, but not all, and we continue to pursue prognostic factors