Stability of mid-shaft clavicle fractures after plate fixation versus intramedullary repair and after hardware removal

Clavicle fractures are a common injury of the shoulder girdle, and a vast majority of these injuries encompass the middle-third of the clavicle. In the past, these fractures were commonly treated non-operatively because they were thought to heal with a low rate of malunion and functional deficits. However, a trend towards operative management of certain fracture types has been observed recently due to studies indicating increased patient dissatisfaction and functional deficits of the shoulder complex following non-operative treatment. Today’s literature suggests that some degree of malunion universally occurs if any fracture dis- placement is present and symptomatic malunion may be more common than previously reported. Furthermore, a recent prospective randomized trial showed improved functional outcomes and lower non-union and malunion rates for surgical fixation. Operative treatment has also been reported to have financial benefits for the patient due to expedited return to work, decreased pain medication consumption, and less time spent in physical therapy. Therefore, a biomechanical evaluation of surgical treatments for mid-shaft clavicle fractures has become necessary to assist clinicians in deciding the optimal surgical method for treatment.

Surgical management of middle-third clavicle fractures may include various techniques for reduction and fixation of the injury. Plate fixation is considered the ‘‘gold standard’’ of operative treatment, providing immediate rigid fixation. Intramedullary (IM) fixation devices are another option, which can be accomplished with less soft tissue dissection, more cosmetic incisions, and they may permit callus formation due to the relative stability with a different complication profile from plate fixation. These complications include plate loosening, plate angulation, plate breakage, irritation of the brachial plexus, infection, delayed union, malunion, non-union, and re-fracture. In addition, complications with IM fixation have been reported and include hardware prominence, implant migration, implant breakage, infection, and re-fracture. The advantages of IM fixation, such as smaller incisions, less dissection and soft tissue stripping, relative protection of the supraclavicular nerves, the load sharing nature of the device, and the ability to remove the implant with the patient under local anaesthesia have been demonstrated in the literature.

To date, little biomechanical data are available investigating and comparing the clinical application and clinically relevant biomechanical strength of plate fixation and locked IM devices. Additionally, no biomechanical data has been reported on the strength of the healed clavicle following hardware removal. The purpose of this study was to biomechanically evaluate the repair strength of a superior locking clavicle plate and a new generation locked IM fixation device for middle-third clavicle fractures in a composite bone model. Comparison between the two constructs to the natural intact state was used to evaluate the biomechanical characteristics of the devices. In addition, the biomechanical stability of the intact clavicle after hardware removal of both devices was assessed. Plate repair was hypothesized to provide higher strength than IM device repair, and IM device removal was predicted to result in higher strength relative to plate removal.

Full Article: Stability of mid-shaft clavicle fractures after plate fixation versus intramedullary repair and after hardware removal

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Stability of mid-shaft clavicle fractures after plate fixation versus intramedullary repair and after hardware removal

About the Author: Peter Millett, MD