Shashi Kumar Yalagach1, Mohammed Tauheed2, Ayyappan V. Nair3, Yon Sik Yoo4, Mruthyunjaya5
PURPOSE
Even though clavicle fractures have a good union rate conservatively, there are several indications for surgical management. Among the surgical techniques open reduction and plate fixation have been used extensively.
Although most surgeons prefer a superior plating technique, an anteroinferior plate location seems to be more advantageous considering the position and reduction of fragments.
MATERIAL AND METHODS
Fifteen consecutive patients with displaced middle-third fracture, delayed unions and non-unions of the clavicle underwent open reduction and internal fixation using an anteroinferior 3.5 mm reconstruction locking compression plate and screws. Patients were evaluated using patient symptoms, clinical signs and radiographic union, the Short Form-36 (SF-36), the American Shoulder and Elbow Surgeons Shoulder Assessment (ASES), and Constant Shoulder Score (CSS) outcomes questionnaire.
RESULTS
The mean age of the patients was 34.6 years (range 19 to 53 years) and all of them (n=15) were males. All patients were satisfied with their shoulder and upper extremity function as well as cosmesis from first week of surgery and were able to carry out their activities of daily living. Mean union time (absence of clinical tenderness and time for radiological union of fracture) was 14.6 weeks, range being 12 to 21 weeks. ASES score was 89. Constant shoulder score was 84 at the latest follow-up.
CONCLUSIONS
Anteroinferior plating of acute displaced middle-third fractures of the clavicle and non-union using 3.5 mm reconstruction locking compression plate typically results in early healing, few complications and an excellent return of function. Advantages of this technique include stable bony fixation with screws directed away from potentially dangerous infraclavicular structures, minimal or no incidence of implant prominence problems and good patient compliance. Further, we would like to emphasise the fact that reduction of small inferior fragments in comminuted fractures and protecting the graft when used in non-unions seems to be other added advantages of this technique.
