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