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Midshaft clavicle fractures: is anterior plating an acceptable alternative to superior plating?

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

Abstract

Purpose

The purpose of this study was to determine whether anterior plating is better tolerated than superior plating for midshaft clavicle fractures.

Methods

This was a prospective non-randomized observational cohort study following operative vs. non-operative management of clavicle fractures from 2003 to 2018 at 7 level 1 academic trauma centers in the USA. The subset of patients treated with plate and screws is the basis for this comparative study. Adults aged 18–85 with closed clavicle fractures displaced over 100% or shortened by more than 1.5 cm were eligible for enrollment. Patients were followed for 2 years following enrollment. Allowable fixation methods at the discretion of the surgeon consisted of anterior–inferior or superior plating. A total of 412 patients were enrolled. Of these, 192 patients received either superior or anterior plating for a displaced clavicle fracture with complete documented prospective research forms capturing type of plating technique. The primary outcome measure was hardware removal (HWR). Secondary outcomes were Disability of the Arm Shoulder and Hand (DASH) score and Visual Analog Pain (VAP) score, and satisfaction score (1 = high satisfaction; 5 = low satisfaction).

Results

There was no difference in HWR rates (7.1% superior 9/127; 6.2% anterior 4/65, p = 0.81), VAP score (mean 1.5 SD 1.0 superior; mean 1.7 SD 0.6 anterior, p = 0.21), DASH score (mean 7.5 SD 12.4 superior; mean 5.2 SD 15.2 anterior; p = 0.18) or satisfaction score (mean 1.6 SD 1.0 superior; mean 1.7 SD 0.60 anterior, p = 0.18).

Conclusion

There is no difference in HWR rates or functional outcomes when using a superior vs. anterior plating technique.

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Acknowledgements

This study was performed through the Southeastern Fracture Consortium with the writing committee consisting of the authors. Each site PI for the Southeastern Fracture Consortium is considered a co-author of this manuscript by the Vancouver model. The authors declare no conflict of interest for this study.

Funding

This study was funded by a grant from the Orthopaedic Trauma Association.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Indiana University, 1801 N Senate Blvd, Ste 535, Indianapolis, IN, 46202, USA

    Brian H. Mullis & Joshua Everhart

  2. Department of Orthopaedics, Prisma Health, Columbia, SC, USA

    Kyle J. Jeray, Stephanie L. Tanner & Becky G. Snider

  3. Spartanburg Regional Health System, Spartanburg, SC, USA

    Scott Broderick

Authors
  1. Brian H. Mullis
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  2. Kyle J. Jeray
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  3. Scott Broderick
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  4. Stephanie L. Tanner
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  5. Becky G. Snider
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  6. Joshua Everhart
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Consortia

Southeastern Fracture Consortium

Contributions

All authors contributed to patient enrollment and participated in manuscript preparation.

Corresponding author

Correspondence to Brian H. Mullis.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Informed consent

This study was IRB approved and all patients provided written informed consent prior to enrollment.

Ethical approval

This study was approved by each institutional IRB, and informed consent was obtained from all patients prior to enrollment. This study complies with current US laws.

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Mullis, B.H., Jeray, K.J., Broderick, S. et al. Midshaft clavicle fractures: is anterior plating an acceptable alternative to superior plating?. Eur J Orthop Surg Traumatol 33, 3373–3377 (2023). https://doi.org/10.1007/s00590-023-03563-5

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  • DOI: https://doi.org/10.1007/s00590-023-03563-5

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