Placing the plate anteroinferiorly on the clavicle provides a more stable construct in terms of bending rigidity with no detriment in axial and torsional stiffness compared with placing the plate superiorly. We believe that anteroinferior plating is preferred as a result of the increase in bending rigidity together with other advantages, including avoidance of neurovascular compromise, the use of longer screws, and decreased hardware prominence.

Historically, anaerobic bacteria as monomicrobial pathogens or components of polymicrobial infections have been found to play a minor role in osteomyelitis. Various Actinomyces species reside as constituents of the normal human microbial flora found in the oropharynx and in the most people may also be present as commensal microorganisms in the gastrointestinal, genitourinary, and, to a lesser degree, the upper respiratory tracts. Bone infections due to Actinomyces species are relatively uncommon and usually associated with concomitant cervicofacial disease. To date, only a sparse amount of cases of long bone osteomyelitis due to Actinomyces bacteria have been published in the medical literature. We report a case of monomicrobial subacute late-onset tibia bone osteomyelitis involving Actinomyces presenting 10 years after an open reduction and internal fixation surgical procedure performed to stabilize a traumatic fracture and review actinomycotic osteomyelitis including the rare association of Actinomyces odontolyticus with long bone infections.