Fixation of displaced midshaft clavicle fractures using precontoured locking compression plate in adults

Abstract

Background: Fractures of the clavicle are one of the injuries which are often inadequately treated. Nonunion, malunion and shortening arising out of nonoperatively treated clavicular fractures cause significant disability due to pain, impaired function of the shoulder joint and limitations of activities. To evaluate the functional outcome following precontoured locking compression plate fixation in displaced midshaft clavicle fractures in adults using Constant and Murley scoring and to assess interrelationship among different covariates. Materials and Methods: Study was conducted at Karpaga Vinayaga Institute of Medical Sciences, Madhuranthagam, Tamil Nadu. Forty patients with displaced midshaft clavicular fractures operated using precontoured locking compression plates were recruited for the study. They are followed up for a period of six months and the outcome was noted. The primary outcome was assessed by Constant-Murley Scoring system and the results were analysed with statistical tools. Results: In our study the mean Constant and Murley scoring was 89.60 at the end of six months. Average time taken for radiological union was 13.45 weeks. We found a statistically significant difference (p value <0.001) in Constant and Murley scores between the first month, third month and sixth months indicating improvement in functional status of the patient over a period of six months after surgery. There were no cases of implant removal due to hardware prominence despite having had this complication in four of our cases (20%). Conclusion:Based on our study, we recommend the use of precontoured locking compression plates for displaced midshaft clavicular fractures. These plates also avoid the need for intra operative contouring and potentially eliminate the necessity of a second surgery for implant removal. Sterile precautions, early surgery, perfect anatomical reduction and early postoperative rehabilitation are needed to achieve favourable results.