Clavicle fracture fixation is becoming an increasingly common operation, with good clinical outcomes and a low rate of significant complications. However, there are several reports of rare but potentially life or limb threatening, neurovascular complications. Arterial injuries are usually pseudoaneurysms associated with prominent screws. These may be clinically silent for several years before presenting as subcritical upper limb ischaemia. Venous injuries are a result of tearing of the vessel wall by fracture manipulation, drills or implants. This produces intra-operative haemorrhage and potentially air embolism, which can be fatal if not rapidly recognized and managed. Brachial plexopathy is the result of traction on adherent plexus or impingement by fracture fragments or callus. It presents as severe arm pain and paralysis immediately postoperatively. Neurovascular injuries can be avoided by a combination of pre-operative planning, communication with anaesthetic staff and strategic surgical technique. The plane of the surgical exposure, release of the soft tissues, drill direction and depth and screw length are all important factors.

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While scapula fractures are often treated nonoperatively, there are a number of displaced fractures in which surgical treatment can be considered. When necessary, open reduction and internal fixation with plates is the accepted method for stabilization. However, there are limited options of commercially available plates for fixation of the scapula. The authors describe 2 cases of scapula fracture and 1 scapula osteotomy that were managed with internal fixation using low-profile mesh plates. The mesh plate is a stainless steel lattice that can be molded and trimmed to create a plate that matches the unusual 3-dimensional anatomy of the scapula. It accepts 2.4/2.7 mm cortical and variable angle locking screws which can be varied up to 15 degrees. We present our experience managing these complex cases, and how the use of the mesh plates facilitated the procedure. No complications were recorded and at final follow-up patients regained satisfactory shoulder functio