Semitubular plates for acutely displaced midclavicular fractures: a retrospective study of 111 patients followed for 2.5 to 6 years

Objectives We designed this study to determine the usefulness of semitubular plates for acute displaced or comminuted fractures of the midclavicle. Design Nonrandomized retrospective study. Setting A secondary transfer hospital specializing in orthopaedics. Patients From May 1997 to July 2001, 121 patients were treated with a 92% (111) follow-up rate. The mean follow-up time was 3.5 years (range, 2.5 to 6 years). Intervention Semitubular plates using 4.5-mm cortical or 6.5-mm cancellous screws and wire as necessary. Main outcome measurement The functional result was evaluated by the Disabilities of the Arm, Shoulder and Hand (DASH) score at the time of admission for implant removal in 82 patients or at the end of follow-up by telephone in 29 patients. Results Most (107 of 111) fractures healed within 6 months. Three patients with implant failure due to backing out of the screws healed after surgical revision. One patient had an infected nonunion with a poor result. The other 110 patients had good results. No implant breakage was noted. No other major complications were noted except for 1 deep infection. No bone graft was needed, even with comminution at the fracture site. Of the 107 patients with uneventful union, 82 had hardware removal. The other 25 were diagnosed as having union both radiographically and clinically and did not have their hardware removed. Conclusion Overall, 95% of patients were satisfied with the surgical procedure. We suggest that a semitubular plate with 4.5-mm cortical and 6.5-mm cancellous screws with wire augmentation if necessary is a reliable procedure for acute severely displaced or comminuted midclavicular fractures.