Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
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The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment

  • Manmohan Patel (Department of Anatomy, All India Institute of Medical Sciences) ;
  • Mohtashim Ahmad (Department of Anatomy, All India Institute of Medical Sciences) ;
  • Natwar Agrawal (Department of Anatomy, NSCB Medical College) ;
  • Sumit Tulshidas Patil (Department of Anatomy, All India Institute of Medical Sciences) ;
  • John Ashutosh Santoshi (Department of Orthopedics, All India Institute of Medical Sciences) ;
  • Bertha Rathinam (Department of Anatomy, All India Institute of Medical Sciences) ;
  • Kusum Rajendra Gandhi (Department of Anatomy, All India Institute of Medical Sciences)
  • Received : 2023.04.21
  • Accepted : 2023.08.08
  • Published : 2023.12.31
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Abstract

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.

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References

  1. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132:617-25. 
  2. Amer KM, Congiusta DV, Suri P, Choudhry A, Otero K, Adams M. Clavicle fractures: associated trauma and morbidity. J Clin Orthop Trauma 2020;13:53-6. 
  3. VanBeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Precontoured plating of clavicle fractures: decreased hardware-related complications? Clin Orthop Relat Res 2011;469:3337-43. 
  4. Andersen JR, Willis MP, Nelson R, Mighell MA. Precontoured superior locked plating of distal clavicle fractures: a new strategy. Clin Orthop Relat Res 2011;469:3344-50. 
  5. Kabak S, Halici M, Tuncel M, Avsarogullari L, Karaoglu S. Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques. J Shoulder Elbow Surg 2004;13:396-403. 
  6. Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma 2006;20:680-6. 
  7. Coupe BD, Wimhurst JA, Indar R, Calder DA, Patel AD. A new approach for plate fixation of midshaft clavicular fractures. Injury 2005;36:1166-71. 
  8. Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, Dijkgraaf MG, Verleisdonk EJ. High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 2017;475:532-9. 
  9. Fontana AD, Hoyen HA, Blauth M, Galm A, Schweizer M, Raas C, Jaeger M, Jiang C, Nijs S, Lambert S. The variance of clavicular surface morphology is predictable: an analysis of dependent and independent metadata variables. JSES Int 2020;4:413-21. 
  10. Malhas AM, Skarparis YG, Sripada S, Soames RW, Jariwala AC. How well do contoured superior midshaft clavicle plates fit the clavicle? A cadaveric study. J Shoulder Elbow Surg 2016;25:954-9. 
  11. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am 2007;89:2260-5. 
  12. Fang CX, Liu R, Yee DKH, Chau J, Lau TW, Chan R, Woo SB, Wong TM, Fang E, Leung F. Comparison of radiological and clinical outcomes, complications, and implant removals in anatomically pre-contoured clavicle plates versus reconstruction plates - a propensity score matched retrospective cohort study of 106 patients. BMC Musculoskelet Disord 2020;21:413. 
  13. Zhao B, Zhao W, Assan I, Bi R. Conoid tubercle angle: attention should be paid to supraclavicular plate fixation. J Orthop Surg Res 2022;17:105.