Functional Outcome of Contoured Anatomical Plate Fixation for Acute Displaced Midshaft Fracture Clavicle

Abstract

BACKGROUND:This prospective study was done to evaluate the effectiveness of implants i.e., anatomical pre contoured dynamic compression plate in treatment of displaced mid shaft clavicular fractures. MATERIALS AND METHODS: fifty patients between 18 and 65 years of age were included in this study. They were treated by fixation with anatomically pre contoured dynamic plate and functional outcome was assessed. Clinical and radiological assessments were performed at regular intervals. Outcomes and complications of over 2 years of follow-up time were compared. RESULTS: Range of motion was well maintained in all the patients. Constant score was excellent in 44 patients (88%) good in 4 patients (8%) and fair in two patients (4%). No patients had a poor result on constant scoring. The mean time to union was 6.8 months. CONCLUSION: In this prospective cohort study, primary open reduction and internal plate fixation of acute displaced mid shaft clavicular fractures resulted in improved outcomes and a decreased rate of nonunion and symptomatic malunion. KEYWORDS: Displaced midshaft clavicle fractures/Anatomical precontoured plating. INTRODUCTION:Clavicle fractures are common injuries accounting for 5-10% of all fractures. Around 80% of clavicle fractures involve the midshaft and over half of these fractures are displaced. 1 The average age of patients sustaining a midshaft clavicular fracture is 33 years; 70% of the patients are male. 2 Traditionally, acute midclavicular fractures have been treated non operatively with either sling or figure-of-eight bandage, with a reported less than 1% rate of fracture nonunion. 3 However, more recent studies have reported nonunion rates of 4-29% and malunion rates of 14-36% with displaced clavicle fractures. 4 Several fixation methods have been reported including plate fixation, 5 intramedullary pin fixation 6 and placement of intramedullary threaded k-wires 7 and elastic intramedullary nails. 8 Earlier indications for surgery include the need for earlier functional mobilization in the patient with an isolated injury, in addition to open fractures, floating shoulders and patients with polytrauma. 9 In recent studies, the trend has moved towards surgical stabilization of selected clavicle fractures, with operative indications including significant shortening or distraction (>1.5 centimeters), displacement greater than 100%, and the presence of a zed fragment. 10 Plate fixation can provide immediate rigid fixation, helping to facilitate early mobilization. 11 A biomechanical study shows that plate fixation provides a more rigid stabilization compared to intramedullary fixation and may provide a stronger construction for early rehabilitation protocols. 12 In this study we evaluated the functional outcome of fixation of clavicle with anatomically contoured plates.