Middle third clavicular fractures fixed with precontoured locking compression plate or reconstruction plate: comparison of outcomes and complications

Abstract

Background: Fractures of the clavicle account for 2.6% to 4% of all fractures. Operative management of displaced fractures of the midshaft clavicle is preferred due to better outcomes. Various plates are used for fixation of these fractures, which include reconstruction plates, dynamic compression plates, and precontoured locking plates. Very few studies have documented whether the proposed benefits of precontoured plates are realized in a clinical setting. In this study, we compared the outcomes and complications of displaced midshaft clavicular fractures fixed using precontoured and reconstruction plates. Methods: Patients with Robinson Type 2B fractures of the clavicle treated using reconstruction plates (46 patients) or precontoured plates (68 patients) were included in the study. Parameters such as duration of surgery, functional outcome at 6 mo, and occurrence of complications, such as nonunion, infection, hardware prominence, and overall reoperation rates, were compared between the two groups. Results: There was no significant difference in functional outcomes between the reconstruction plate group and precontoured plate group (Constant score: 85.23 vs. 86.75, respectively). However significantly higher rate of hardware prominence (32.6% vs. 7.3%, respectively), implant removal (15.2% vs. 2.9%, respectively), and reoperation (19.5% vs. 4.4%, respectively) was found with reconstruction plates compared to precontoured plates. Conclusions: The treatment of displaced midshaft clavicular fractures with either reconstruction plates or precontoured plates offers a return to excellent shoulder function. However, a significant decrease in duration of surgery, hardware prominence, and reoperation rate was seen with precontoured plates.

Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis

“…Concerning superior locking plates, 23 studies were identified. 1 , 2 , 4 , 9 , 10 , 12 , 13 , 17 , 19 , 20 , 24 , 28 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 63 , 66 , 76 The average patient age from all studies was 37.8 years (range 17-79) with mean length of follow-up of 29.3 months. Five studies reported a Constant-Murley Score (CMS) 14 at 6 months, 1 of these studies did not include a standard error.…”

“…Five studies reported a Constant-Murley Score (CMS) 14 at 6 months, 1 of these studies did not include a standard error. 20 , 35 , 36 , 57 , 66 Four studies reported CMS scores at 12 months, 1 of these did not report standard errors. 36 , 40 , 57 Four studies reported DASH 28 scores at 12 months of which 1 study did not report standard errors.…”

“…Eight studies concerning superior reconstruction plates were included in the systematic review. 3 , 5 , 18 , 26 , 35 , 45 , 58 , 65 The mean age of patients was 35.7 years (range 15-57). The average length of follow-up for all studies in the systematic review was 33.3 months.…”

“…The CMS at 6 months was reported in 3 studies. 3 , 35 , 65 One study reported DASH scores at 6 months (9.9). 3 …”