Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

Abstract

Introduction: The concept of treating displaced, middle third fractures of clavicle by open reduction and stable fixation thereby restoring the clavicular length is gaining more and more acceptance amongst trauma surgeons. The aim of our study was to analyze the clinical outcome of internal fixation of middle third clavicle fracture by anatomical pre-contoured plate. Method: 125 patients with isolated displaced middle third clavicle fractures were treated by open reduction and anatomical pre-contoured locking compression plate and followed prospectively till six months after union. All patients were assessed radiologically, clinically and according to disability of arm, shoulder and hand scoring system (DASH). Results: Average time of union was 8 weeks. Union rate in our study was 97.6%. Most of the patients returned to pre-injury working status by the end of 10 weeks. Average DASH score at the end of 6 months was 12. Conclusion: Superiorly placed anatomical pre-contoured locking plate for operative treatment of displaced middle third fractures is a safe and effective option with early return to pre injury working level and at the same time avoiding potential complications of delayed union, non-union and mal-union.Keywords: clavicle fracture, non-union, mal-union, anatomical clavicle plate Introduction Clavicle fractures are common due to indirect mechanism being fall on an out-stretched hand, accounting for upto 2.6% to 10% of all fractures and upto 44.1% of the fractures involving upper girdle [1] . Fractures of middle third account for approximately 80% of all clavicular injuries. Traditionally, these fractures have been managed non-operatively, even when substantially displaced [2] , with good to excellent results [3, 4] . The limitations of conservatively treated fractures are increased risk of non-union and mal-union resulting in altered biomechanics of upper girdle, cosmetic dissatisfaction and upper extremity weakness [5][6][7][8] . These factors have caused a gradual shift towards surgical treatment of this fracture [7, 9] . Many devices have been described for treatment by internal fixation that included circlage wires, Steinmann pins, Kirschner wires, Knowel's pins, Rush rods, Recon plates etc [10][11][12] . The proponents who favor ORIF in these fractures emphasize on early and accurate reduction achieving clavicular length resulting in quicker pain relief and early functional recovery. As the consensus for operative treatment picks-up, recent studies show lower incidence of nonunion and mal-union rates and early return to work compared to conservative treatment