Fracture of the medial end of the clavicle is very rare. There is no consensus on the standard surgical strategy for medial clavicle fracture, and treatment is challenging. This study aimed to retrospectively evaluate the efficacy of internal plate fixation for displaced medial clavicle fracture.
Patients who underwent internal plating of a displaced medial clavicle fracture were included in this retrospective study. Each patient underwent open reduction and fixation with an internal extra-articular locking plate or trans-articular hook plate based on their fracture type. Postoperative follow-up included radiographs for assessment of bone union, Constant-Murley score for shoulder function, Disability of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, and visual analog scale (VAS) for pain. Any complications were also recorded.
Between May 2014 and July 2021, 34 patients (9 females, 25 males; mean age, 50.0 ± 14.8 years) were treated with internal plate fixation and included in this study. The fracture line was located in the medial fifth of the clavicle in 32 patients, and 20 patients had intra-articular fracture. Eighteen patients had the fracture fixed with a locking plate, namely an inverted distal clavicle plate (n = 7), straight locking plate (n = 3), distal fibular plate (n = 3), and T-plate (n = 5); the other 16 patients were treated with a clavicle hook plate. During a mean follow-up of 30.7 ± 26.5 months, 33 patients achieved bone healing, the average Constant-Murley score was 90.9 ± 11.0 points, the mean DASH score was 6.0 ± 6.6 points, and the mean VAS was 0.4 ± 1.1 points. Complications occurred in five patients.
Both locking plates and hook plates are effective in treating displaced medial clavicle fracture. A locking plate is recommended when there is enough bone stock in the medial fragment for stable fixation. A clavicle hook plate is recommended for cases in which the medial clavicle fracture is too small, comminuted, or has signs of sternoclavicular joint instability.
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- Clavicle fractures in adults; current concepts.Eur J Trauma Emerg Surg. 2020; 46: 519-529https://doi.org/10.1007/s00068-019-01122-4
- Fractures of the clavicle in the adult. Epidemiology and classification.J Bone Joint Surg Br. 1998; 80: 476-484https://doi.org/10.1302/0301-620x.80b3.8079
- Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures.BMC Musculoskelet Disord. 2021; 22: 905https://doi.org/10.1186/s12891-021-04775-8
- Displaced medial-end clavicle fractures treated with locking plate osteosynthesis.Med Sci Monit. 2019; 25: 7591-7596https://doi.org/10.12659/MSM.916922
- Fractures of the medial end of the clavicle.J Shoulder Elbow Surg. 2007; 16: 49-54https://doi.org/10.1016/j.jse.2006.05.010
- Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture.J Bone Joint Surg Am. 2004; 86: 1359-1365https://doi.org/10.2106/00004623-200407000-00002
- Operative outcome of displaced medial-end clavicle fractures in adults.J Shoulder Elbow Surg. 2008; 17: 751-754https://doi.org/10.1016/j.jse.2008.01.139
- Operative management of periarticular medial clavicle fractures-report of 10 cases.J Trauma Acute Care Surg. 2012; 72: E1-E7https://doi.org/10.1097/TA.0b013e31820d1354
- The operative outcomes of displaced medial-end clavicle fractures.J Shoulder Elbow Surg. 2015; 24: 1728-1734https://doi.org/10.1016/j.jse.2015.04.011
- Balser plate stabilization for traumatic sternoclavicular instabilities or medial clavicle fractures: a case series and literature review.Orthop Surg. 2020; 12: 1627-1634https://doi.org/10.1111/os.12726
- Displaced medial clavicle fractures: operative treatment with locking compression plate fixation.Eur J Trauma Emerg Surg. 2020; 46: 207-213https://doi.org/10.1007/s00068-018-1024-6
- Treatment of bipolar clavicle injury with internal plating: a case series and literature review.BMC Musculoskelet Disord. 2023; 24: 8https://doi.org/10.1186/s12891-023-06126-1
- What are the functional outcomes and pain scores after medial clavicle fracture treatment?.Clin Orthop Relat Res. 2021; 479: 2400-2407https://doi.org/10.1097/CORR.0000000000001839
- Bipolar injury of the clavicle.Orthopedics. 2018; 41: e681-e688https://doi.org/10.3928/01477447-20180724-02
- Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture.J Orthop Surg (Hong Kong). 2017; 252309499016684488https://doi.org/10.1177/2309499016684488
- Zlomeniny mediálního klíku–Souhrnný referát [Fractures of sternal end of the clavicle–current concept review].Rozhl Chir. 2008; 87 (Czech): 480-485
- Sternoclavicular joint reconstruction in the setting of medial comminuted clavicle fracture.Arthrosc Tech. 2017; 6: e1355-e1359https://doi.org/10.1016/j.eats.2017.05.026
- A sternoclavicular joint-specific plate for the displaced medial-end clavicle fracture.Front Surg. 2022; 9875475https://doi.org/10.3389/fsurg.2022.875475
- A new technique for medial-end comminuted clavicle fractures.Injury. 2019; 50: 811-813https://doi.org/10.1016/j.injury.2019.02.002
- A cross-sectional anatomical study of the retrosternal pre-vascular space in the mediastinum [in Chinese].Sichuan J Anatomy. 1999; 7: 123-124
- Displaced medial end clavicular fractures treated with an inverted distal clavicle plate contoured through 90 degrees.J Shoulder Elbow Surg. 2019; 28: e97-e103https://doi.org/10.1016/j.jse.2018.08.04
Published online: March 17, 2023
Accepted: March 16, 2023
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