Screws are at a safe distance from critical structures after superior plate fixation of clavicle fractures

  • Joshua A. ParryEmail author
  • Lori R. Chambers
  • Kenneth J. Koval
  • Joshua R. Langford
Original Article • SHOULDER - IMAGING



Injuries to the critical structures underlying the clavicle are possible during open reduction and internal fixation (ORIF) and afterward secondary to prominent screws. The purpose of this study was to identify patients who received chest computerized tomography (CT) scans after clavicle ORIF to evaluate the distance between the screws and the subclavian vessels.


A retrospective review was performed at a single level-one trauma center. Nineteen patients with chest CT scans after superior plate fixation were included. Coronal CT reconstructions were analyzed to determine distances between the subclavian vessels and screw tips along with the prominence of the screws. Vessels within 15 mm of the screw were considered at risk.


None of the screws (0/142) were within 15 mm of the subclavian vessels. Average screw prominence was 1.3 ± 1 mm (range, 0–3.6 mm). One of the 19 patients had a complication, a re-fracture requiring revision ORIF. The remaining 18 patients had no complications, including neurovascular or pulmonary, at the last follow-up.


None of the screws were excessively prominent or within 15 mm of the subclavian vessels. Attentive superior plate fixation of the clavicle with screws is a safe technique.

Level of evidence

Level IV, case series.


Clavicle Superior plate Subclavian vessels Screw path Injury 


Author contribution

All authors made substantial contributions to the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article or revising it, and gave final approval of the submitted version.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None of the authors have financial conflicts of interest relevant to the content of this study. This study complies with the current laws of the country in which it was performed.


  1. 1.
    Woltz S, Stegeman SA, Krijnen P et al (2017) Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures. J Bone Jt Surg 99:106–112. CrossRefGoogle Scholar
  2. 2.
    Altamimi SA, McKee MD, Canadian Orthopaedic Trauma Society (2008) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. J Bone Jt Surg Am 90:1–8. CrossRefGoogle Scholar
  3. 3.
    Ahrens PM, Garlick NI, Barber J, Tims EM (2017) The clavicle trial. J Bone Jt Surg 99:1345–1354. CrossRefGoogle Scholar
  4. 4.
    Robinson L, Persico F, Lorenz E, Seligson D (2014) Clavicular caution: an anatomic study of neurovascular structures. Injury 45:1867–1869. CrossRefGoogle Scholar
  5. 5.
    Persico F, Lorenz E, Seligson D (2014) Complications of operative treatment of clavicle fractures in a level I trauma center. Eur J Orthop Surg Traumatol 24:839–844. CrossRefGoogle Scholar
  6. 6.
    Toth MJ, Yoon RS, Liporace FA, Koval KJ (2017) What’s new in ankle fractures. Injury. Google Scholar
  7. 7.
    Clitherow HD, Bain GI (2015) Major neurovascular complications of clavicle fracture surgery. Shoulder Elb 7:3–12. CrossRefGoogle Scholar
  8. 8.
    Qin D, Zhang Q, Zhang Y-Z et al (2010) Safe drilling angles and depths for plate-screw fixation of the clavicle: avoidance of inadvertent iatrogenic subclavian neurovascular bundle injury. J Trauma Inj Infect Crit Care 69:162–168. CrossRefGoogle Scholar
  9. 9.
    Werner SD, Reed J, Hanson T, Jaeblon T (2011) Anatomic relationships after instrumentation of the midshaft clavicle with 3.5-mm reconstruction plating: an anatomic study. J Orthop Trauma 25:657–660. CrossRefGoogle Scholar
  10. 10.
    Stillwell A, Ioannou C, Daniele L, Tan SLE (2017) Osteosynthesis for clavicle fractures: how close are we to penetration of neurovascular structures? Injury 48:460–463. CrossRefGoogle Scholar
  11. 11.
    Sinha A, Edwin J, Sreeharsha B et al (2011) A radiological study to define safe zones for drilling during plating of clavicle fractures. J Bone Jt Surg Br 93:1247–1252. CrossRefGoogle Scholar
  12. 12.
    Clitherow HDS, Bain GI (2014) Association between screw prominence and vascular complications after clavicle fixation. Int J Shoulder Surg 8:122–126. CrossRefGoogle Scholar
  13. 13.
    Mulder FJ, Mellema JJ, Ring D (2016) Proximity of vital structures to the clavicle: comparison of fractured and non-fractured side. Arch Bone Jt Surg 4:318–322Google Scholar
  14. 14.
    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. CrossRefGoogle Scholar
  15. 15.
    Nourian A, Dhaliwal S, Vangala S, Vezeridis PS (2017) Midshaft fractures of the clavicle. J Orthop Trauma 31:461–467. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Denver Health Medical Center, University of Colorado School of MedicineDenverUSA
  2. 2.Memorial HospitalGulfportUSA
  3. 3.Orlando HealthOrlandoUSA

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