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Anterior and superior plate positions in diaphyseal clavicle fractures produce similar patient outcomes

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

While diaphyseal clavicle fractures can be treated with plate fixation on either the superior or anteroinferior aspect of the clavicle, the optimal plate position remains controversial. The purpose of this study was to determine if anteroinferior vs. superior plating for clavicle fracture fixation leads to better patient outcomes.

Methods

A retrospective review of patients who sustained clavicle fractures (OTA/AO 15.2) treated with superior or anteroinferior plating at a tertiary Level I trauma center from 2015 to 2021 was performed. The clinical outcomes of clavicle fractures were compared between groups treated with an anterior versus a superior approach via Mann–Whitney U and Chi-squared tests as appropriate to evaluate for differences in outcomes between the two plate positions.

Results

A total of 315 diaphyseal clavicle fractures were identified. One hundred and forty patients were excluded due to inadequate follow-up. Of the remaining 175 patients, 25 were treated with an anteroinferior approach (14%) and 150 were treated with a superior approach (86%). There were no differences in age, BMI, tobacco use, or substance use between the two groups (p > 0.05 for all). On univariate analysis, there was no difference in rate of union (p = 0.60), nerve injury (p = 0.60), infection (p = 1.0), implant-related irritation (p = 0.42), implant removal (p = 0.26), or revision (p = 1.0) based on approach. Contoured plates had an association with risk of nerve injury (p = 0.04).

Conclusion

There are no differences in union, nerve injury, infection, symptomatic implant, or revision rate between anteroinferior and superior clavicle approaches. Plate positioning during diaphyseal clavicle fracture fixation can reasonably be dictated based on surgeon preference and ideal reduction quality.

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References

  1. Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11:452–456

    Article  PubMed  Google Scholar 

  2. van der Meijden OA, Gaskill TR, Millett PJ (2012) Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg 21:423–429

    Article  PubMed  Google Scholar 

  3. Stenson J, Baker W (2021) Classifications in brief: the modified neer classification for distal-third clavicle fractures. Clin Orthop Relat Res 479:205–209

    Article  PubMed  Google Scholar 

  4. Saha P, Datta P, Ayan S, Garg AK, Bandyopadhyay U, Kundu S (2014) Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures: A comparative study. Indian J Orthop 48:587–593

    Article  PubMed  PubMed Central  Google Scholar 

  5. McKee RC, Whelan DB, Schemitsch EH, McKee MD (2012) Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 94:675–684

    Article  PubMed  Google Scholar 

  6. Nourian A, Dhaliwal S, Vangala S, Vezeridis PS (2017) Midshaft fractures of the clavicle: a meta-analysis comparing surgical fixation using anteroinferior plating versus superior plating. J Orthop Trauma 31:461–467

    Article  PubMed  Google Scholar 

  7. Ai J, Kan SL, Li HL, Xu H, Liu Y, Ning GZ et al (2017) Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis. BMC Musculoskelet Disord 18:159

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kloen P, Werner CM, Stufkens SA, Helfet DL (2009) Anteroinferior plating of midshaft clavicle nonunions and fractures. Oper Orthop Traumatol 21:170–179

    Article  PubMed  Google Scholar 

  9. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R (2002) Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg 11:457–462

    Article  CAS  PubMed  Google Scholar 

  10. Fahey EJ, Galbraith JG, Kaar K (2019) A single centre experience of pre-contoured clavicle plates by an anterior approach. J Orthop 16:171–174

    Article  PubMed  PubMed Central  Google Scholar 

  11. Salazar LM, Koso RE, Momtaz DA, Dutta AK (2022) Results of pre-contoured titanium anterior plating of midshaft clavicle fractures. J Shoulder Elbow Surg 31:107–112

    Article  PubMed  Google Scholar 

  12. Formaini N, Taylor BC, Backes J, Bramwell TJ (2013) Superior versus Anteroinferior plating of clavicle fractures. Orthopedics 36:e898–e904

    Article  PubMed  Google Scholar 

  13. Serrano R, Borade A, Mir H, Shah A, Watson D, Infante A et al (2017) Anterior-Inferior plating results in fewer secondary interventions compared to superior plating for acute displaced Midshaft clavicle fractures. J Orthop Trauma 31:468–471

    Article  PubMed  Google Scholar 

  14. Sohn HS, Shon MS, Lee KH, Song SJ (2015) Clinical comparison of two different plating methods in minimally invasive plate Osteosynthesis for clavicular midshaft fractures: a randomized controlled trial. Injury 46:2230–2238

    Article  PubMed  Google Scholar 

  15. Hulsmans MH, van Heijl M, Houwert RM, Timmers TK, van Olden G, Verleisdonk EJ (2016) Anteroinferior versus superior plating of clavicular fractures. J Shoulder Elbow Surg 25:448–454

    Article  PubMed  Google Scholar 

  16. Subramanian P, Joshi M, Shilston S, Wallace D, Pearce OJ (2013) Treatment of middle-third clavicle fractures using anterior plating with a dynamic compression plate (DCP). Tech Hand Up Extrem Surg 17:35–36

    Article  PubMed  Google Scholar 

  17. Hussey MM, Chen Y, Fajardo RA, Dutta AK (2013) Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. J Orthop Trauma 27:627–632

    Article  PubMed  Google Scholar 

  18. Marie C (2015) Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input. Med Biol Eng Comput 53:759–769

    Article  PubMed  Google Scholar 

  19. Toogood P, Coughlin D, Rodriguez D, Lotz J, Feeley B (2014) A biomechanical comparison of superior and anterior positioning of precontoured plates for midshaft clavicle fractures. Am J Orthop (Belle Mead NJ) 43:E226–E231

    PubMed  Google Scholar 

  20. Wilkerson J, Paryavi E, Kim H, Murthi A, Pensy RA (2017) Biomechanical comparison of superior versus anterior plate position for fixation of distal clavicular fractures: a new model. J Orthop Trauma 31:e13–e17

    Article  PubMed  Google Scholar 

  21. Robertson C, Celestre P, Mahar A, Schwartz A (2009) Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between nonlocked and locked plates in two different positions. J Shoulder Elbow Surg 18:204–209

    Article  PubMed  Google Scholar 

  22. Worhacz K, Nayak AN, Boudreaux RL, Pavan B, Wipf Dipl-Ing F, Jacofsky MC et al (2018) Biomechanical analysis of superior and anterior precontoured plate fixation techniques for neer type II-A clavicle fractures. J Orthop Trauma 32:e462–e468

    Article  PubMed  Google Scholar 

  23. Bravman JT, Taylor ML, Baldini T, Vidal AF (2015) Unicortical versus bicortical locked plate fixation in midshaft clavicle fractures. Orthopedics 38:e411–e416

    Article  PubMed  Google Scholar 

  24. Prasarn ML, Meyers KN, Wilkin G, Wellman DS, Chan DB, Ahn J et al (2015) Dual mini-fragment plating for midshaft clavicle fractures: a clinical and biomechanical investigation. Arch Orthop Trauma Surg 135:1655–1662

    Article  PubMed  Google Scholar 

  25. Boyce GN, Philpott AJ, Ackland DC, Ek ET (2020) Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study. J Orthop Surg Res 15:248

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kitzen J, Paulson K, Korley R, Duffy P, Martin CR, Schneider PS (2022) Biomechanical evaluation of different plate configurations for midshaft clavicle fracture fixation: single plating compared with dual mini-fragment plating. JB JS Open Access 7:109–235

    Google Scholar 

  27. Mendes Junior AF, Tavares AK, Oppe IG, Pires RE, Belangero WD, Labronici PJ (2022) Pre-contoured superior locking plates offer poor bone fit for midshaft clavicle fracture fixation: cadaveric analysis of 4 commercially available systems. Rev Col Bras Cir 49:e20223177

    PubMed  Google Scholar 

  28. Bauer DE, Hingsammer A, Schenk P, Vlachopoulos L, Imam MA, Fürnstahl P et al (2018) Are commercially-available precontoured anatomical clavicle plating systems offering the purported superior optimum fitting to the clavicle? A cadaveric analysis and review of literature. Orthop Traumatol Surg Res 104:755–758

    Article  CAS  PubMed  Google Scholar 

  29. Pavone V, C DEC, Testa G, Canavese F, Lucenti L, Sessa G (2018) Does age affect outcome in children with clavicle fracture treated conservatively? Quick Dash and MRC evaluation of 131 consecutive cases. Minerva Pediatr 2:1–13

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Margaret A. Sinkler, Ryan J. Furdock, Christopher J. McMellen, Kirsten Boes & George Ochenjele

  2. Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Margaret A. Sinkler, Margaret Wang & Andy Kuo

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  1. Margaret A. Sinkler
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  2. Margaret Wang
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  3. Andy Kuo
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Correspondence to Margaret A. Sinkler.

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Sinkler, M.A., Wang, M., Kuo, A. et al. Anterior and superior plate positions in diaphyseal clavicle fractures produce similar patient outcomes. Eur J Orthop Surg Traumatol 33, 2331–2336 (2023). https://doi.org/10.1007/s00590-022-03428-3

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  • DOI: https://doi.org/10.1007/s00590-022-03428-3

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