Risk Factors for Clavicle Refracture after Plate Removal: A Systematic Review and Meta-Analysis

Although uncommon, clavicle refracture following plate removal poses a major clinical concern. Identifying risk factors may help guide decisions on patient selection for plate removal. The study aims to systematically review and meta-analyze the available literature on risk factors associated with clavicle refracture after plate removal. We conducted a search in PubMed, Scopus, and ScienceDirect and included studies that compared patients with and without refracture after clavicle plate removal. Risk factors were pooled using odds ratios (OR) and standardized mean differences (SMDs), with a random or fixed-effects model depending on heterogeneity. The Newcastle-Ottawa Scale was used to appraise the quality of studies. Five retrospective studies were included, comprising a total of 1,135 patients who met the inclusion criteria. We found that female gender (OR: 0.30; 95% CI: 0.18–0.51) was associated with a lower observed refracture incidence, although this finding is likely confounded. In contrast, lower body weight SMD: 0.65; 95% CI: 0.28–1.03), smaller clavicle diameter (SMD: 0.57; 95% CI: 0.15–0.98), and shorter clavicle length (SMD: 0.68; 95% CI: 0.26–1.09) were significantly associated with an increased risk of refracture. This is the first meta-analysis to identify risk factors for clavicle refracture following plate removal. These findings may inform cautious risk–benefit discussions but do not support individualized prognostication at this time. Overall, the certainty is low, and these results should be interpreted as hypotheses to be tested in future studies, rather than as definitive predictors to guide clinical decision-making.