Plate configuration in midshaft clavicle fractures: influence of working length, screw number, and plate length-a retrospective cohort study of 355 patients.

INTRODUCTION: Midshaft clavicle fractures are commonly treated with plate fixation; however, the selected plate working length varies widely. Biomechanical principles suggest potential effects on fracture healing, but clinical evidence remains limited, and the roles of screw number and plate length are not well defined. This study evaluated whether plate working length, screw number, and plate length influence callus formation, complications, or implant removal in operatively treated diaphyseal clavicle fractures. METHODS: This retrospective single-center study included patients aged ≥ 16 years treated with plate fixation for diaphyseal clavicle fractures between 2016 and 2024. Implant configuration and clinical outcomes were extracted from the institutional database. Patients were grouped by the number of free plate holes adjacent to the fracture (0, 1, 2, or ≥ 3). Radiographic healing was assessed by three independent observers. Statistical analyses included chi-square tests, ANOVA or Kruskal–Wallis tests depending on data distribution. RESULTS: Among 355 patients, plate working length showed no association with callus formation, complications, or implant removal. Constructs with mechanical implant failure contained fewer screws on average than those without failure (6.43 vs. 7.14 screws), although the number of failure events was small. Plate length showed no significant relationship with callus formation or complications. CONCLUSION: Plate working length showed no meaningful association with healing or complication rates. Constructs with mechanical implant failure contained fewer screws on average, suggesting that secure screw fixation may be more relevant for construct performance than modifications of working length or plate length. Plate length itself did not significantly influence outcomes. LEVEL OF EVIDENCE: Level III, retrospective cohort study.