Usefulness of double plate fixation after failed ORIF for clavicle shaft fracture

Seung Hun Woo; Jung Yun Bae; Sung Won Jung; Min-Hyeok Choi; Suk-Woong Kang

doi:10.1007/s00590-024-03927-5

Usefulness of double plate fixation after failed ORIF for clavicle shaft fracture

Eur J Orthop Surg Traumatol. 2024 Apr 10. doi: 10.1007/s00590-024-03927-5. Online ahead of print.

Authors

Seung Hun Woo¹, Jung Yun Bae¹, Sung Won Jung¹, Min-Hyeok Choi^{2

3}, Suk-Woong Kang⁴

Affiliations

¹ Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea.
² Department of Preventive and Occupational & Environmental Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
³ Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
⁴ Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea. redmaniak@naver.com.

PMID: 38598169
DOI: 10.1007/s00590-024-03927-5

Abstract

Purpose: We aimed to evaluate the clinical and radiological outcomes of double plate fixation for failed clavicle shaft fracture surgery.

Materials and methods: We analyzed 14 patients who underwent double plate fixation due to plate failure after clavicle shaft fracture surgery from March 2016 to March 2021. The study used 3.5 mm locking compression plates for superior clavicle and anterior reconstruction in all patients. In addition, moldable allograft bone was used to fill the bone defect. Clinical and radiological evaluation was performed immediately, at 2 and 4 weeks, and 3, 6, 9, and 12 months postoperatively. The visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder scale, and American Shoulder and Elbow Surgeons (ASES) scores and range of motion of the shoulder were evaluated as clinical results. For radiological evaluation, anteroposterior, caudal, and cephalad views of both clavicles were used. Successful bone union was defined as complete adjoining of the fracture site through callus formation.

Results: Successful bone union was achieved in all patients, and the mean time to bone union was 16.7 ± 1.2 weeks (range, 12-24 weeks). Statistically significant improvement in forward flexion and external and internal rotation was observed from 135.5° ± 6.3, 45.2° ± 5.3, and 13° ± 2.3 preoperatively to 157.0° ± 9.3, 68.7° ± 6.3, and 9.8° ± 3.1 at the final follow-up, respectively. The VAS score improved from an average of 6.2 ± 2.8 preoperatively to 1.3 ± 0.7 at the final follow-up, which was statistically significant (P = 0.018). In addition, the ASES score significantly increased from a mean of 52.1 ± 6.3 points preoperatively to 83.6 ± 7.8 points at the final follow-up (P = 0.001). The average UCLA shoulder score was 16.7 ± 1.4 and 31.4 ± 2.2 points preoperatively and at the final follow-up, respectively, which was statistically significant (P = 0.001).

Conclusion: Double plate fixation has shown good results after failed open reduction and internal fixation (ORIF) for clavicle shaft fractures. Therefore, in complicated situations after ORIF, double plate fixation is considered a surgical treatment option.

Keywords: Clavicle; Clavicle mid-shaft fracture; Clavicle shaft; Dual plate fixation; Locking compression plate; Nonunion; Plate failure.