Abstract
Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
Key words
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Article info
Publication history
Published online: March 17, 2023
Accepted:
March 16,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
