Skip to main content

Advertisement

SpringerLink
Log in

Dual mini-fragment plate fixation of midshaft clavicle fractures is biomechanically equivalent to anatomic pre-contoured plating

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objectives

To biomechanically compare the stiffness of midshaft synthetic clavicle osteotomies fixed with either superior anatomic pre-contoured locking plates, anterior anatomic pre-contoured locking plates, or short-segment dual orthogonal mini-plate fixation.

Design and Setting

Controlled laboratory study.

Specimens

Twenty-one synthetic pre-osteotomized clavicles were separated into three groups: superior plating, anterior plating, or dual-plating. Each clavicle was sequentially tested in non-destructive cycles of axial compression, three-point bending, and torsion. Load and displacement were recorded. Stiffness was calculated.

Results

No statistically significant differences were found between construct stiffness during axial compression, three-point bending, or torsional testing. One superior plated clavicle suffered catastrophic failure during axial compression. One dual mini-fragment plated clavicle suffered catastrophic failure during torsion.

Conclusions

Orthogonal dual mini-fragment fixation of transverse clavicle fractures is biomechanically similar to superior and anterior pre-contoured anatomic locking plate fixation. No statistically significant differences in construct stiffness were found in axial compression, three-point bending, or torsion testing. Further clinical research is required to determine the long-term stability of dual mini-fragment plate fixation.

Level of Evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Burnham JM, Kim DC, Kamineni S (2016) Midshaft clavicle fractures: a critical review. Orthopedics 39:1–9

    Article  Google Scholar 

  2. Wiesel B, Nagda S, Mehta S et al (2018) Management of midshaft clavicle fractures in adults. J Am Acad Orthop Surg 26(22):e468–e476

    Article  PubMed  Google Scholar 

  3. Neer CS (1960) Nonunion of the clavicle. JAMA 172:1006–1011

    Article  Google Scholar 

  4. Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79(4):537–539

    Article  CAS  PubMed  Google Scholar 

  5. McKee MD, Pedersen EM, Jones C et al (2006) Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 88(1):35–40

    PubMed  Google Scholar 

  6. Robinson CM, Court-Brown CM, McQueen MM et al (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86-A(7):1359–1365

    Article  Google Scholar 

  7. Simpson N, Jupiter J (1996) Clavicular nonunion and malunion: evaluation and surgical management. J Am Acad Orthop Surg 4(1):1–8

    Article  CAS  PubMed  Google Scholar 

  8. Melean PA, Zuniga A, Marsalli M et al (2015) Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population. J Shoulder Elbow Surg 24(4):587–592

    Article  PubMed  Google Scholar 

  9. Mirzatolooei F (2011) Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Acta Orthop Traumatol Turc 45(1):34–40

    Article  PubMed  Google Scholar 

  10. Canadian Orthopaedic Trauma Society (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89(1):1–10

    Article  Google Scholar 

  11. Robinson CM, Goudie EB, Murray IR et al (2013) Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am 95(17):1576–1584

    Article  CAS  PubMed  Google Scholar 

  12. Woltz S, Stegeman SA, Krijnen P et al (2017) Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures: A multicenter randomized controlled trial. J Bone Joint Surg Am 99(2):106–112

    Article  PubMed  Google Scholar 

  13. Virtanen KJ, Remes V, Pajarinen J et al (2012) Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial. J Bone Joint Surg Am 94(17):1546–1553

    Article  PubMed  Google Scholar 

  14. Woltz S, Krijnen P, Schipper IB (2017) Plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am 99(12):1051–1057

    Article  PubMed  Google Scholar 

  15. Nourian A, Dhaliwal S, Vangala S et al (2017) Midshaft fractures of the clavicle: A meta-analysis comparing surgical fixation using anteroinferior plating versus superior plating. J Orthop Trauma 31(9):461–467

    Article  PubMed  Google Scholar 

  16. Prasarn ML, Meyers KN, Wilkin G et al (2015) Dual mini-fragment plating for midshaft clavicle fractures: a clinical and biomechanical investigation. Arch Orthop Trauma Surg 135(12):1655–1662

    Article  PubMed  Google Scholar 

  17. Czajka CM, Kay A, Gary JL et al (2017) Symptomatic implant removal following dual mini-fragment plating for clavicular shaft fractures. J Orthop Trauma 31(4):236–240

    Article  PubMed  Google Scholar 

  18. Chen X, Shannon SF, Torchia M et al (2017) Radiographic outcomes of single versus dual plate fixation of acute mid-shaft clavicle fractures. Arch Orthop Trauma Surg 137(6):749–754

    Article  PubMed  Google Scholar 

  19. DeBaun MR, Chen MJ, Campbell ST et al (2020) Dual mini-fragment plating is comparable with precontoured small fragment plating for operative diaphyseal clavicle fractures. J Orthop Trauma 34(7):e229–e232

    Article  PubMed  Google Scholar 

  20. Shannon SF, Chen X, Torchia M et al (2016) Extraperiosteal dual plate fixation of acute mid-shaft clavicle fractures: a technical trick. J Orthop Trauma 30(10):e346–e350

    Article  PubMed  Google Scholar 

  21. Lee C, Feaker DA, Ostrofe AA et al (2020) No difference in risk of implant removal between orthogonal mini-fragment and single small-fragment plating of midshaft clavicle fractures in a military population. Clin Orthop Relat Res 478(4):741–749

    Article  PubMed  Google Scholar 

  22. Hulsmans MH, van Heijl M, Houwert RM et al (2018) Surgical fixation of midshaft clavicle fractures: a systematic review of biomechanical studies. Injury 49(4):753–765

    Article  PubMed  Google Scholar 

  23. Boyce GN, Philpott AJ, Ackland DC et al (2020) Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study. J Orthop Surg Res 15(1):452–457

    Article  Google Scholar 

  24. Ziegler CG, Aman ZS, Storaci HW et al (2019) Low-profile dual small plate fixation is biomechanically similar to larger superior or anteroinferior single plate fixation of midshaft clavicle fractures. Am J Sports Med 47(11):2678–2685

    Article  PubMed  Google Scholar 

  25. Partal G, Meyers KN, Sama N et al (2010) Superior versus anteroinferior plating of the clavicle revisited: a mechanical study. J Orthop Trauma 24(7):420–425

    Article  PubMed  Google Scholar 

  26. Iannolo M, Werner FW, Sutton LG et al (2010) Forces across the middle of the intact clavicle during shoulder motion. J Shoulder Elbow Surg 19(7):1013–1017

    Article  PubMed  Google Scholar 

  27. Hoogervorst P, Bolsterlee B, Pijper M et al (2019) Forces acting on the clavicle during shoulder abduction, forward humeral flexion and activities of daily living. Clin Biomech 69:79–86

    Article  CAS  Google Scholar 

  28. Rehn CH, Kirkegaard M, Viberg B, Larsen MS (2014) Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults: a systematic review. Eur J Orthop Surg Traumatol 24:1047–1053

    Article  PubMed  Google Scholar 

  29. Drosdowech DS, Manwell SEE, Ferreira LM et al (2011) Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma 25(1):39–43

    Article  PubMed  Google Scholar 

  30. Uzer G, Yildiz F, Batar S et al (2017) Biomechanical comparison of three different plate configurations for comminuted clavicle midshaft fracture fixation. J Shoulder Elbow Surg 26(12):2200–2205

    Article  PubMed  Google Scholar 

  31. Goswami T, Markert RJ, Anderson CG et al (2008) Biomechanical evaluation of a pre-contoured clavicle plate. J Shoulder Elbow Surg 17(5):815–818

    Article  PubMed  Google Scholar 

  32. Pulos N, Yoon RS, Shetye S et al (2016) Anteroinferior 2.7-mm versus 3.5-mm plating of the clavicle: a biomechanical study. Injury 47(8):1642–1646

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank the Orthopaedic Trauma Association for their generous grant that provided funding for our synthetic clavicles and our biomechanical testing. We would also like to thank Stryker for donating the plates and screws that were used within this study.

Funding

Funding for this study was provided by a research grant from the Orthopaedic Trauma Association. OTA Grant #1712.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada

    Devin P. Ferguson, Patrick Theriault & Andrew Trenholm

  2. Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA

    Hayden P. Baker & Daryl Dillman

  3. Nova Scotia Health Authority, Halifax, NS, Canada

    Kelly Trask & Shelley MacDonald

Authors
  1. Devin P. Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hayden P. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daryl Dillman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Theriault
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kelly Trask
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shelley MacDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew Trenholm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hayden P. Baker.

Ethics declarations

Conflict of interest

Ferguson D.P. declares he has no conflicts of interest. Baker H.P. declares he has no conflicts of interest. Dillman D. declares he has no conflicts of interest. Theriault P. declares he has no conflicts of interest. Trask K. declares she has no conflicts of interest. MacDonald S. declares she has no conflicts of interest. Trenholm A. declares he has no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferguson, D.P., Baker, H.P., Dillman, D. et al. Dual mini-fragment plate fixation of midshaft clavicle fractures is biomechanically equivalent to anatomic pre-contoured plating. Eur J Orthop Surg Traumatol 33, 1109–1116 (2023). https://doi.org/10.1007/s00590-022-03268-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-022-03268-1

Keywords

Search

Navigation