Treating displaced fracture of proximal clavicle with an inverted anatomic locking plate for distal clavicle

Abstract

Objective To explore clinical and radiological outcomes of treating displaced fractures of proximal clavicle by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle. Methods From August 2013 to August 2015, 12 patients with displaced fracture of proximal clavicle were treated in our hospital by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle. They were 11 men and one woman, with an average age of 43.5 years (range, 25 to 62 years). There were 9 fresh and 2 old fractures. According to the Edinburgh classification, 10 fractures were classified as type 1B1 and 2 as type 1B2. After fixation, the 180° inverted plate on the ipsilateral side was placed on the superior aspect of proximal clavicle. The medial fragment was fixed with 2 to 4 pieces of 2.7 mm multidirectional locking screw and the lateral fragment with 2 to 3 pieces of 3.5 mm locking screw. X-ray and CT were performed to assess union, delayed union, nonunion, and hardware failure. Functional outcomes were assessed by Constant-Murley scores and Disabilities of the Arm, Shoulder and Hand (DASH) scores at final follow-ups. Results There were no significant neurovascular injuries intraoperatively. All patients were followed up for an average of 15.6 months (range, 12 to 24 months). All fractures healed after an average of 14.3 weeks (range, 8 to 24 weeks). At final follow-ups, the mean Constant-Murley score was 96.0 points (range, 84 to 100 points) and the mean DASH score 1.9 points (range, 0 to 14.8 points). There were no such significant complications as infection, reduction loss or implant failure. Conclusion Displaced fractures of proximal clavicle may be treated with an inverted anatomic locking plate for distal clavicle on the ipsilateral side because of rigid fixation, fine stability and good chance for early rehabilitation. Key words: Clavicle; Sternoclavicular joint; Fracture fixation, internal; Treatment outcome