Surgical technique of low-profile dual plating for midshaft clavicle fractures.

OBJECTIVE

The aim of this surgical technique is fracture healing with anatomical alignment and less implant irritation due to smaller, low-profile plates. Equal to superior stability is provided compared to single superior- or anterior-based plates.

INDICATIONS: The same general indications for surgical stabilization of clavicle fractures apply for low-profile double plating and include fracture displacement of one or more shaft width, shortening of more than 1 cm in length, and patients with high physical activity levels. Double plating is especially suitable for fractures in the midportion of the clavicle.

CONTRAINDICATIONS: Fractures in the far lateral portion of the clavicle due to physiological thinning of the clavicle potentially causing problems with screw purchase of screws fitted in the anterior plate.

SURGICAL TECHNIQUE: A 2.0 mm low-profile mini plate is used on the superior and a 2.4 or 2.7 mm on the anterior surface of the clavicle. The plates are fixated with a minimum of two cortical or locking screws on each side of the fracture in each plate. A lag screw can be used if absolute stability can be obtained in simple fractures.

POSTOPERATIVE MANAGEMENT: A standard functional postoperative regime can be followed after plate fixation with free mobilization up to 90° without weight bearing for 6 weeks. Afterwards free range of motion and weight bearing are allowed.

RESULTS

A biomechanical study, meta-analysis, and retrospective analysis have shown that low profile double plating offers equal to superior stability, lower rates of implant irritation and subsequent removal compared to conventional single plating with equal healing potential.