Sat., 10/20/07 Upper Extremity, Paper #53, 10:30 am OTA-2007
Comparison of Superior and Anteroinferior Plate Placement in the Treatment of Clavicle Fractures
Robert S. Rice, MD* (n); S. Andrew Sems, MD1 (n); Michael E. Torchia, MD1 (n);
Peter A. Cole, MD2 (a-Biomet/EBI, DePuy, Smith+Nephew, Synthes, Zimmer);
Adam Bloemke, MD2 (n); Andrew H. Schmidt, MD3 (e-Smith+Nephew);
1Mayo Clinic, Rochester, Minnesota, USA;
2University of Minnesota-Regions Hospital, St. Paul, Minnesota, USA;
3Hennepin County Medical Center, Minneapolis, Minnesota, USA
Purpose: Surgical treatment of diaphyseal clavicular fractures is a controversial and debated issue that has recently received support in the orthopaedic literature. Recent studies have shown that nonoperative treatment is not uniformly associated with a successful outcome. The purpose of this study is to determine whether there is a difference between fixation with plates placed along the superior aspect of the clavicle and fixation with plates placed on the anteroinferior aspect of the clavicle.
Methods: Over a 5.5-year period, open reduction and internal fixation for displaced midshaft clavicle fractures (OTA code 6) was performed in 96 clavicles at three Level I trauma centers in Minnesota. A chart and radiographic review of all patients who underwent plate fixation of diaphyseal clavicle fractures from January 2001 through July 2006 was undertaken. Evaluation of preoperative, immediate postoperative, as well as all subsequent radiographs was performed to evaluate the OTA fracture classification and to assess fracture union, loss of reduction, and hardware failure. Review of patient charts and clinical notes was performed to determine if patients required reoperation for nonunion, infection, delayed union, or for plate removal.
Results: Plates were located on the superior aspect of the clavicle in 41 (42.7 %) of fractures while 55 (57.3%) were plated in an anteroinferior fashion. There was no difference in the groups with regard to age, gender, mechanism of injury, or fracture type. Nonunion was present in two cases—one in the anteroinferior group and one in the superior group. Reoperation occurred in 13 patients, including 10 for painful hardware, 1 for infection, and 2 for repeat open reduction and internal fixation secondary to nonunion. There was a trend toward higher reoperation rates with the plate in the superior position (8/41, 19.5%) compared to the anteroinferior position (5/55, 9.1%) but the difference was not statistically significant.
Conclusion: This study confirms the high overall success rate of surgically treated midshaft clavicle fractures using plate fixation. No statistically significant differences were detected with regard to union or infection rates between anteroinferior and superior plating. Plate placement on the superior aspect of the clavicle trended towards higher reoperation rates. Although this is the largest comparative study of the two plating methods to our knowledge, because of the potential type II statistical error that exists in this study, larger-scale studies are appropriate in order to obtain more definitive data.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.