Anteroinferior 2.7-mm Versus 3.5-mm Plating for AO/OTA Type B Clavicle Fractures

Abstract

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Anteroinferior 2.7-mm versus 3.5-mm plating of the clavicle: A biomechanical study

“…The authors found that the greatest axial compressive force comes during humeral abduction with approximately 145 N of force, while maximum torque was generated during external rotation with approximately 56 N of force, values significantly lower than our presented data for both constructs [19]. With significantly lower forces experienced in an intact clavicle, this may be the reason why there were no differences in union rates or failure rates when 2.7 mm plates were compared to 3.5 mm plates in the clinical setting; the increased flexibility may have also resulted in the trend towards higher functional outcomes in the 2.7 mm group [11].…”

“…Fortunately, authors have reported good clinical results following operative fixation of clavicle fractures with high union and low complication rates [3,[8][9][10][11][12][13][14][15]. One of the more common complications is hardware related irritation and prominence leading to relatively high rates of removal, particularly with superior and anterosuperior plating.…”

“…While not all fractures are amenable to anterorinferior plating, including those with inferior comminution, proponents argue that the inferior position yields lower hardware irritation and removal rates [10,11,[16][17][18]. A recent study, conducted by Galdi et al, compared anteroinferior 2.7 mm vs. 3.5 mm plating in the clinical scenario with no notable differences in union rates, but a lower incidence of hardware irritation with the lower profile hardware [11]. To our knowledge, the mechanical properties of anteroinferior plate fixation of midshaft clavicle fractures with 2.7 mm non-locking reconstruction plates has not been investigated.…”

“…To combat this complication, techniques including intramedullary nails and anteroinferior plating have arisen with equally good results [10,11,[16][17][18]. While not all fractures are amenable to anterorinferior plating, including those with inferior comminution, proponents argue that the inferior position yields lower hardware irritation and removal rates [10,11,[16][17][18]. A recent study, conducted by Galdi et al, compared anteroinferior 2.7 mm vs. 3.5 mm plating in the clinical scenario with no notable differences in union rates, but a lower incidence of hardware irritation with the lower profile hardware [11].…”

“…More recently, however, several authors have shown that outcome of these fractures treated nonoperatively are not as satisfactory as once thought with patients complaining of decreased strength and endurance [3][4][5][6][7][8]. Thus, in addition to absolute indications for fixation including open fractures, floating shoulder and those with compromised soft tissue from skin tenting, operative indications of midshaft clavicle fractures have broadened to include those with significant shortening, displacement, and comminution.Fortunately, authors have reported good clinical results following operative fixation of clavicle fractures with high union and low complication rates [3,[8][9][10][11][12][13][14][15]. One of the more common complications is hardware related irritation and prominence leading to relatively high rates of removal, particularly with superior and anterosuperior plating.…”