Dual Versus Single-Plate Fixation of Midshaft Clavicular Fractures

Abstract

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Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study

“…Allis et al reviewed 44 patients with midshaft clavicle fractures managed with either 3.5-mm superior plating or dual mini-fragment plate fixation [16]. Reoperation rates were significantly lower in patients managed with dual mini-fragment plates than those managed with a 3.5-mm superior plate, primarily due to less frequent metalware irritation (0% vs. 29%, p = 0.008).…”

“…The benefit of dual plating may be twofold: firstly, improved strength may reduce construct failure, and secondly, stronger constructs may allow the use of minimally prominent low-profile plates. Allis et al recently compared dual mini-plates to standard superior plates for midshaft clavicle fractures and found significantly fewer reoperations for metalware irritation in the dual mini-plate cohort [16]. Few biomechanical studies exist comparing these constructs.…”

Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures

“…Non-union was reported in 10 studies. [29][30][31][45][46][47][49][50][51][52] The overall non-union rate was 3.4%, with 0.8% (N ¼ 254) of dual plated and 2.9% (N ¼ 339) of single plated clavicles going on to nonunion. Pooled comparison across the five comparative studies 45,46,49,51,52 demonstrated no significant difference in the odds of fracture non-union with dual and single plate fixation methods (OR, 0.60; 95% CI, 0.13 to 2.79; P ¼ 0.52) (Figure 2(a)).…”

“…Complications. Complications were described in 10 studies [29][30][31][45][46][47][48][49][50][51] and included intraoperative and postoperative complications such as neurovascular injury and infection. Complications were defined in a heterogenous manner across studies, as such, we defined a complication as an unintended negative outcome other than non-union, delayed union, and reoperation, which were reported separately in this review.…”

“…Hardware removal occurred in 4.4% (N ¼ 318) and 12.3% (N ¼ 309) of patients undergoing dual and single plate fixation, respectively. Among the four comparative studies, 45,46,49,51 dual plating resulted in a 77% lower odds of hardware removal compared to single plate fixation (OR, 0.23; 95% CI, 0.07 to 0.78; P ¼ 0.02) (Figure 2 29 2.7-mm superior and 2.4-mm antero-inferior mini-fragment plates 3.5-mm superior or antero-inferior locking reconstruction plate Qamar et al 30 Two 3.5-mm one-third semi-tubular plates -Shannon et al 31 One-third tubular, one-quarter tubular or 2.0-mm superior or anterior mini-fragment plates with 2.7-mm or 3.5-mm pelvic reconstruction plates or 3.5-mm superior locking compression plate -Zhuang et al 52 3.5-mm superior locking compression plate or reconstruction plate and anteroinferior mini-fragment ''aid plate'' 3.5-mm antero-inferior locking compression plate S Sheth et al…”