How is plate-and-screw fixation performed in the treatment of group I clavicle fractures?

Updated: Jan 14, 2019
  • Author: Benjamin P Kleinhenz, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Surgical fixation with a plate and screws is another option for midshaft clavicle fractures. [37] An incision is made in line with the clavicle and carried sharply down to the periosteum, with caution to leave thick skin flaps for closure. The periosteum is then stripped to expose and reduce the fracture, after which plate-and-screw fixation is performed using any of a wide variety of plates. Recommendations vary from semitubular plates to dynamic compression plates, low-contact dynamic compression plates, and double plating. However, fixation of these fractures with semitubular or reconstruction plates is not as strong biomechanically as fixation with dynamic compression plating or the newer locking-plate technology.

Obtaining purchase in 6 cortices on either side of the fracture is recommended. Lag screw fixation is also appropriate when the fracture pattern allows. Again, cancellous bone grafting is suggested in fractures with comminution and/or bone loss.

Mehmet et al conducted an evaluation of the biomechanical properties and the stability of a locking clavicle plate (LCP), a dynamic compression plate (DCP), and an external fixator (Ex-fix) and found significant differences between them. The investigators used an unstable displaced clavicle fracture model under torsional and 3-point bending loading. For torsion and bending, an overall significant difference was found between the 3 types of fixation equipment in terms of failure loads; a significant difference was also noted between the LCP and the other 2 models in terms of initial stiffness. The LCP was significantly more stable than the DCP and Ex-fix when subjected to torsional and bending cyclic loading. [38]


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