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Precontoured Plating of Clavicle Fractures: Decreased Hardware-related Complications?

  • Symposium: Fractures of the Shoulder Girdle
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal.

Questions/purposes

We compared the outcomes after precontoured and noncontoured superior plating of acute displaced midshaft clavicle fractures. Primary outcomes were rate of plate prominence, rate of hardware removal, and rate of complications. Secondary outcomes were ROM and pain and function scores.

Patients and Methods

We retrospectively reviewed 52 patients with 52 acute, displaced midshaft clavicle fractures treated with either noncontoured or precontoured superior clavicle plate fixation. Fourteen patients with noncontoured plates and 28 with precontoured plates were available for followup at a minimum of 1 year postoperatively. Postoperative assessment included ROM, radiographs, and subjective scores including visual analog scale for pain, American Shoulder and Elbow Surgeons questionnaire, and Simple Shoulder Test.

Results

Patients complained of prominent hardware in nine of 14 in the noncontoured group and nine of 28 in the precontoured group. Hardware removal rates were three of 14 in the noncontoured group and three of 28 in the precontoured group. Postoperative ROM and postoperative subjective scores were similar in the two groups.

Conclusions

Precontoured plating versus noncontoured plating of displaced midshaft clavicle fractures results in a lower rate of plate prominence in patients who do not undergo hardware removal.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997;43:778–783.

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  3. Chandrasenan J, Espag M, Dias R, Clark DI. The use of anatomic pre-contoured plates in the treatment of mid-shaft clavicle fractures. Injury Extra. 2008;39:171–171.

    Article  Google Scholar 

  4. Chen CH, Chen JC, Wang C, Tien YC, Chang JK, Hung SH. Semitubular plates for acutely displaced midclavicular fractures: a retrospective study of 111 patients followed for 2.5 to 6 years. J Orthop Trauma. 2008;22:463–466.

    Article  PubMed  Google Scholar 

  5. Cohen J. A power primer. Psychol Bull. 1992;112:155–159.

    Article  PubMed  CAS  Google Scholar 

  6. Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma. 2006;20:680–686.

    Article  PubMed  Google Scholar 

  7. Godfrey J, Hamman R, Lowenstein S, Briggs K, Kocher M. Reliability, validity, and responsiveness of the Simple Shoulder Test: psychometric properties by age and injury type. J Shoulder Elbow Surg. 2007;16:260–267.

    Article  PubMed  Google Scholar 

  8. Golish SR, Oliviero JA, Francke EI, Miller MD. A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res. 2008;3:28.

    Article  PubMed  Google Scholar 

  9. Goswami T, Markert RJ, Anderson CG, Sundaram SS, Crosby LA. Biomechanical evaluation of a pre-contoured clavicle plate. J Shoulder Elbow Surg. 2008;17:815–818.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am. 2007;89:2260–2265.

    Article  PubMed  Google Scholar 

  12. Kabak S, Halici M, Tuncel M, Avsarogullari L, Karaoglu S. Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques. J Shoulder Elbow Surg. 2004;13:396–403.

    Article  PubMed  Google Scholar 

  13. Lee HG. Treatment of fracture of the clavicle by internal nail fixation. N Engl J Med. 1946;234:222–224.

    Article  PubMed  CAS  Google Scholar 

  14. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35–40.

    Article  PubMed  Google Scholar 

  15. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am. 2003;85:790–797.

    PubMed  Google Scholar 

  16. Mullaji AB, Jupiter JB. Low-contact dynamic compression plating of the clavicle. Injury. 1994;25:41–45.

    Article  PubMed  CAS  Google Scholar 

  17. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006–1011.

    PubMed  Google Scholar 

  18. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma. 1998;12:572–576.

    Article  PubMed  CAS  Google Scholar 

  19. Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg. 2004;13:479–486.

    Article  PubMed  Google Scholar 

  20. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop. 2005;76:496–502.

    Article  PubMed  Google Scholar 

  21. Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury. 1992;23:237–241.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3:347–352.

    Article  Google Scholar 

  24. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86:1359–1365.

    PubMed  Google Scholar 

  25. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968;58:29–42.

    Article  PubMed  CAS  Google Scholar 

  26. Shen WJ, Liu TJ, Shen YS. Plate fixation of fresh displaced midshaft clavicle fractures. Injury. 1999;30:497–500.

    Article  PubMed  CAS  Google Scholar 

  27. Thyagarajan D, Day M, Dent C, Williams R, Evans R. Treatment of mid-shaft clavicle fractures: a comparative study. Int J Shoulder Surg. 2009;3:23–27.

    Article  Google Scholar 

  28. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13:227–236.

    Article  PubMed  CAS  Google Scholar 

  29. Wick M, Muller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001;121:207–211.

    Article  PubMed  CAS  Google Scholar 

  30. Woo SL, Lothringer KS, Akeson WH, Coutts RD, Woo YK, Simon BR, Gomez MA. Less rigid internal fixation plates: historical perspectives and new concepts. J Orthop Res. 1984;1:431–449.

    Article  PubMed  CAS  Google Scholar 

  31. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19:504–507.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Shoulder, Elbow and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street PH 11, New York, NY, 10032, USA

    Corinne VanBeek MD, Karen J. Boselli MD, Edwin R. Cadet MD, Christopher S. Ahmad MD & William N. Levine MD

Authors
  1. Corinne VanBeek MD
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  2. Karen J. Boselli MD
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  3. Edwin R. Cadet MD
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  4. Christopher S. Ahmad MD
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  5. William N. Levine MD
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Corresponding author

Correspondence to William N. Levine MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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VanBeek, C., Boselli, K.J., Cadet, E.R. et al. Precontoured Plating of Clavicle Fractures: Decreased Hardware-related Complications?. Clin Orthop Relat Res 469, 3337–3343 (2011). https://doi.org/10.1007/s11999-011-1868-0

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  • DOI: https://doi.org/10.1007/s11999-011-1868-0

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