Anatomical compatibility of precontoured clavicular locking compression plates: a 3D patient-specific modeling approach with clinical correlation.

BACKGROUND

Precontoured clavicular locking compression plates (LCP) aim to minimize implant-related complications by providing a close fit to the clavicle's complex morphology. Nevertheless, the inherent anatomical variation observed across patients can lead to discrepancies between implant and bone, potentially contributing to suboptimal fit and an increased risk of complications requiring reoperation.

OBJECTIVE

This study analyzed the anatomical compatibility of precontoured clavicular LCPs, detailing their fit characteristics and exploring the correlation between these findings and clinical outcomes.

METHOD: Fifty-six 3D, patient-specific clavicular models were reproduced from patients undergoing clavicular fixation (2018-2024). These models were created using 3D printing based on individual 3D-CT reconstructions. Two commercially available clavicular LCP designs were virtually assessed for anatomical compatibility using Computer-Aided Design (CAD) technology. Additionally, a retrospective evaluation of patient outcomes following fracture fixation with the LCPs was conducted. Correlation analysis was used to investigate the relationship between plate compatibility and implant-related complications, as well as reoperation rates.

RESULT: Our findings revealed a significant inverse relationship between plate length and compatibility, with longer plates demonstrating reduced overlap, increased overhang, and lower bicortical screw purchase rates. Clinically, 19.64% of patients required hardware removal due to symptomatic hardware, while 33.93% experienced implant prominence. Importantly, our analysis revealed a significant negative correlation between plate compatibility and both implant-related complications and the need for reoperation.

CONCLUSION

The currently available precontoured clavicular LCPs exhibit suboptimal fit, particularly in the lateral region of the clavicle. These findings highlight the importance of selecting the appropriate plate and improving plate designs to enhance anatomical conformity and potentially reduce the incidence of implant-related complications.

LEVEL OF EVIDENCE: Level III (Translational Study).