Management of comminuted mid-shaft clavicular fractures: Comparison between dual-plate fixation treatment and single-plate fixation

Abstract

Background: We consider dual-plate fixation to improve construct rigidity in cases with fracture complexity. The purpose of this study is to compare the rate of nonunion, prognosis, and complications at 6–12 months for surgically treated acute mid-shaft clavicle fractures when extra-periosteal dual-plate fixation is used in place of the conventional single-plate fixation. Materials and Methods: The comparative study was conducted on 47 patients who received acute mid-shaft clavicular fracture treatment in our hospital from March 2015 to July 2018. All patients were divided into dual-plate fixation treatment (group A) and single-plate fixation (group B). Patients undergoing single-plate fixation were compared to dual-plate fixation. Patients were followed up for 6–12 months. Charts were reviewed to assess union rates, prognosis, and complications. Results: Forty-seven clavicles (30 single plates and 17 dual plates) were evaluated. All patients (100%) in dual plating group and 128 (93.3%) in single plating group obtained bony union by 1 year. When comparing groups at 3 months, radiographic union was present in 50.0% of single plates and 64.7% in the dual plating group ( p = 0.032). However, at 6 months, no significant difference existed (90.0% vs. 94.1%, p = 0.297). Comparing groups at 1.5 and 6 months, Constant–Murley outcome scores were present with no significant difference ( p = 0.129, p = 0.054) between single plates and dual plating group. However, at 3 months, significance difference existed. Discussion: Three months after the operation, patients with dual-plate fixation showed good functional recovery. Extra-periosteal dual plating for acute mid-shaft clavicle fractures can be safely considered for the treatment of complex acute mid-shaft clavicle fractures without increasing the risk of nonunion or revision. Conclusions: Open reduction and internal fixation with an extra-periosteal dual plating technique is a reliable option for treatment of acute mid-shaft clavicle fractures, especially in the setting of severely comminuted fractures and in situations where bone quality is questionable and additional fixation is desired.

Outcomes and complications after dual plate vs. single plate fixation of displaced mid-shaft clavicle fractures: A systematic review and meta-analysis

“…Included studies were published between 2011 and 2020, and all studies were retrospective in nature. Five of the studies were retrospective cohort studies, 11,13,14,16,17 and three were case series. 7,12,15 Of the included studies, five reported on patients surgically treated with only mini-fragment plates, 7,12e14,17 and three included patients treated with dual plate fixation consisting of a combination of mini-fragment and smallfragment plates (Table 1).…”

“…7,12,15 Of the included studies, five reported on patients surgically treated with only mini-fragment plates, 7,12e14,17 and three included patients treated with dual plate fixation consisting of a combination of mini-fragment and smallfragment plates (Table 1). 11,15,16 The mean age of patients was 36.0 years and the majority were male (n ¼ 201; 79.8%). Patients were followed post-operatively for a mean of 8.3e35.0 months.…”

“…All comparative studies were included in the meta-analysis due to the limited number of studies available. Four of the retrospective cohort studies included in the meta-analysis had a moderate risk of bias, 11,13,14,17 and one had a serious risk of bias, 16 when assessed using the ROBINS-1 score (Appendix C).…”

Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures

“…Hardware removal occurred in 4.4% (N ¼ 318) and 12.3% (N ¼ 309) of patients undergoing dual and single plate fixation, respectively. Among the four comparative studies, 45,46,49,51 dual plating resulted in a 77% lower odds of hardware removal compared to single plate fixation (OR, 0.23; 95% CI, 0.07 to 0.78; P ¼ 0.02) (Figure 2 29 2.7-mm superior and 2.4-mm antero-inferior mini-fragment plates 3.5-mm superior or antero-inferior locking reconstruction plate Qamar et al 30 Two 3.5-mm one-third semi-tubular plates -Shannon et al 31 One-third tubular, one-quarter tubular or 2.0-mm superior or anterior mini-fragment plates with 2.7-mm or 3.5-mm pelvic reconstruction plates or 3.5-mm superior locking compression plate -Zhuang et al 52 3.5-mm superior locking compression plate or reconstruction plate and anteroinferior mini-fragment ''aid plate'' 3.5-mm antero-inferior locking compression plate S Sheth et al…”

Open reduction and plate fixation versus sling in treatment of mid-shaft fractures of clavicle

“…[ 1 ] In the past, non-surgical treatment has been preferred for axial clavicular fractures because of the extremely low rate of bone nonunion, even in the case of significant displacement. [ 2 , 3 ] However, a number of scholars have recently found that nonoperative displaced fractures have a higher rate of nonunion than previously reported. At present, a consensus has been reached on the non-surgical treatment of undisplaced central clavicle fractures.…”