Search

Clavicle fractures account for 2.6% to 4% of all fractures. Surgical stabilization of this type of injury is becoming more common. Anterior inferior plating and superior plating are 2 popular approaches to open reduction and internal fixation. Reports of plate removal have raised concerns about reinjury. The goal of the current study was to determine whether the orientation of screw holes in clavicles after removal of an anterior inferior plate vs a superior plate have different biomechanical effects on stiffness and load to failure. The medial and lateral ends of 28 matched pairs of fresh clavicles were potted. Pilot holes, 2.5 mm in diameter, were drilled and oriented anterior inferiorly or superiorly, simulating those left after removal of a plate for a middle-third fracture. The clavicles underwent dynamic axial compression and 3-point load to failure, replicating forces associated with reinjury. Clavicles with anterior inferior holes had a statistically significant higher median maximal load difference of 139 N compared with those with superior holes (P=.013). Anterior inferior holes showed a statistically significant median increase in stiffness of 16.3 N/mm compared with superior holes (P=.036). Clavicles with anterior inferior holes had a statistically significant increase in median maximal load to failure and an increase in median stiffness compared with those with superior holes. This finding is relevant for patients who undergo hardware removal and return to activities that put them at risk for repeat high-impact injuries to the clavicle., (Copyright 2015, SLACK Incorporated.)

Objectives: To examine the anatomic relationships of the major neurovascular structures at the midshaft clavicle region as they pertain to plate osteosynthesis in the treatment of midshaft clavicle fractures., Methods: Fifteen fresh cadaveric specimens were dissected at the clavicle region. The shortest distances from the midshaft clavicular fracture lines to the subclavian artery and vein and brachial plexus were measured with a digital caliper with the limb in anatomic position and at 90° of abduction. The mean and range distance values were recorded. The clavicles were then instrumented with eight-hole, 3.5-mm reconstruction plates and screws (Synthes, Paoli PA) placed in superior and anteroinferior positions. The shortest distances from the screw tips to the neurovascular structures were measured at variable plate positions, fracture zones, and limb positions. The incidence of screw tip contact was reported., Results: In 20% (three of 15) of the specimens, screw tip contact with a major neurovascular structure occurred. In these three specimens, two screw tip contacts occurred with the plate in a superior position and two occurred with the plate in an anteroinferior position. In one specimen, screw tip contact occurred with both plate positions. Limb abduction to 90° consistently increased the distance of the neurovascular structures from the clavicle. There was no observable trend in screw contact frequency in respect to limb position or fracture zone., Conclusion: Caution must be exercised when instrumenting midshaft clavicle fractures regardless of chosen plate position. Limb abduction to 90° provides an added measure of safety during clavicle instrumentation.