The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment

Abstract

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.

Keywords: Bone plate; Clavicle; Fracture fixation; Fracture malunion; Orthopedic procedures.

Fig. 1

(A) Showing anatomical pre-countered superior anterior clavicle plate (SACP) without lateral extension (B) anatomical pre-countered SACP, with lateral extension.

Fig. 2

Showing the mismatch of congruence of length/distance at the medial end of clavicle marked by black dotted line and red arrow indicating the gap between clavicle and plate. At arrow 1, ther is minimum gap while at arrow 3 the gap is maximum.

Fig. 3

Showing the measurement of anteroposterior congruence of plate to the underlying clavicle at lateral end with reference to anterior margin. If the plate is directed backwards as direction of red arrow, the value noted in positive number and if it extends beyond the border of bone, the value noted as negative as directed by yellow arrow.

Fig. 4

Showing vertical gap between the bone and plate at the medial end of the clavicle. The gap is indicated by red arrow.