Does the addition of demineralized bone matrix to fixation of acute comminuted clavicle fractures affect healing outcomes?

Abstract

To assess the healing outcomes of patients who sustained a comminuted clavicle fracture and underwent operative fixation with or without the addition of demineralized bone matrix (DBM). A total of 271 comminuted midshaft clavicle fractures that presented to our hospital system and underwent operative fixation with a plate and screw construct were retrospectively reviewed. Data collected include patient demographics, initial injury information, and use of demineralized bone matrix during surgery to enhance bone healing. Patients were grouped based on whether or not their fixation was augmented with DBM. Fracture-related infection (FRI), lack of fracture healing, and the need for revision fracture surgery were reviewed. Adhesive capsulitis of the shoulder and screw back out were categorized as "minor complications." Clinical healing was defined as non-tenderness about the fracture site, and radiographic healing was defined as presence of bridging callus and lack of fracture line on X-ray. Chi-square, T-test, and linear regression analysis were used to determine any significant differences between cohorts. Sixty-nine patients had DBM used in their repair, and 202 patients did not. Cohorts had a similar follow-up (range: 6-18 months). There were no differences in patient demographics or fracture pattern between the two groups (P > 0.05 for all). There were no differences in major and minor complications; however, the cohort treated with DBM had shorter time to radiographic healing, confirmed with regression analysis (P < 0.05). Augmentation of midshaft clavicle fracture constructs with DBM was associated with quicker radiographic healing.