Practice patterns in indications, timing, and imaging for clavicle hardware removal: a survey among German-speaking shoulder surgeons

BACKGROUND: Clavicle hardware removal is a standard secondary procedure after fracture fixation, yet clinical decision-making regarding indications, timing, imaging, and postoperative recommendations remains highly variable. Despite the frequency of this intervention, no study to date has systematically assessed real-world practice patterns among shoulder and trauma surgeons in the German-speaking region. The purpose of this study was to evaluate current indications, preferred timing, imaging strategies, and postoperative recommendations related to clavicle hardware removal. METHODS: A cross-sectional, web-based survey was distributed to members of the German-speaking Shoulder and Elbow Society (DVSE). The questionnaire assessed surgeon demographics, surgical experience, annual volume of hardware removal, indications for removal (general and absolute), preferred timing, imaging modalities used for preoperative planning, the influence of fracture location, and recommendations for return to sports. Only complete responses were included in the final analysis. RESULTS: A total of 198 surgeons completed the survey. Irritation (90.9%) and patient preference (87.9%) were the most frequently selected indications for hardware removal, whereas infection (56.6%) was the predominant absolute indication for removal. Most surgeons favored delayed removal: 38.9% recommended hardware removal after more than 18 months, and 42.9% relied on radiographic consolidation as the primary determinant of when to remove the hardware. Radiographs were routinely obtained (99.0%), while CT scans were used selectively (37.4%), particularly for early elective procedures. Most respondents reported no fracture-location-specific differences in removal frequency, although lateral fractures were most cited among those indicating variation. Recommendations for return to sport varied widely, with most surgeons allowing resumption of athletic activity between 6 and 12 weeks postoperatively. CONCLUSION: Despite the high volume of clavicle hardware removal procedures, management strategies remain heterogeneous, underscoring persistent uncertainty in indications, timing, imaging protocols, and return-to-sport advice.