THE USE OF ANATOMIC PRECONTOURED PLATES IN THE TREATMENT OF MIDSHAFT CLAVICLE FRACTURES

Abstract

The aim of this study was to assess the outcome of a pre-contoured anatomic plate in the treatment of midshaft clavicle fractures.

We treated thirty patients consecutively for middle third clavicle fractures between March 2001 to March 2006. Surgery was performed for acute fractures, non-unions and malunions by a senior surgeon.

Fifteen patients were treated by open reduction and internal fixation with a precontoured small fragment clavicle plate (mean age of thirty-eight years).

Our control group consisted of a consecutive series of fifteen patients treated by internal fixation with conventional plates (mean age of forty-one years). Ten patients had fixation of their clavicles with a reconstruction plate whilst five patients had fixation with a dynamic compression plate (DCP).

Outcomes assessed for both groups were; complications, need for removal of plate, post-operative outcome, and time to union.

All patients were followed up for an average of eighteen months (range eight to thirty months). In the pre-contoured plate group none required removal of hardware. Five patients had complications. Three of these patients complained of numbness around the caudal aspect of the wound which subsequently resolved within six to eight weeks of the operation. The remaining two patients suffered from adhesive capsulitis postoperatively. Their symptoms resolved completely after four months. All patients regained full range of motion. All patients went on to clinical and radiological union with average time to union being 4.7 months (range three to ten months).

In the conventional plate group, nine patients required removal of their plate. Average time to removal of plate from index operation was 7.7 months (range four to thirteen months). Of the nine plate removals there were two plate breakages, five removals for local soft tissue irritation and two persistent painful non-unions. Three patients required subsequent re-plating for non-unions. All fractures united in this group with mean time to union of 5.4 months (range 2 to 14 months).

A pre-contoured clavicle plate provides rigid fixation without compromising plate stiffness and fatigue strength. We have successfully treated patients with acute fractures, nonunions and malunions of midshaft clavicle fractures, where there was gross distortion of normal anatomy. None of our patients required the removal of their plates (minimum follow-up of 8 months). We have also found these plates to be a valuable anatomical template when reconstructing a malunion, nonunion or highly comminuted fracture.

In conclusion, this is the first reported series demonstrating the use of anatomical pre-contoured plates for clavicle fractures. They can reduce time spent on intra-operative contouring, are low-profile and thus far, plate removal has not been necessary.