gms | German Medical Science

Objectives: Fracture of the medial clavicle is a very rare injury with no consensus on the standard surgical strategy, treatment is challenging for a surgeon. This study aimed to retrospectively evaluate the efficacy of internal plate fixation for displaced medial clavicle fractures.

Methods: Patients with displaced medial clavicle fractures that underwent internal plating were included in this retrospective study. Each patient underwent open reduction and internal extra-articular locking plates or trans-articular hook plates fixation based on their fracture type. Postoperative follow-up included radiographs for assessment of bone union, Constant-Murley score for shoulder function, Disability of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, and visual analog scale (VAS) for pain. Also, any complications were also recorded.

Results: From May 2014 to July 2021, 34 patients (9 females, 25 males; mean age, 50.0±14.8 years) treated with internal plate fixation were included in this study. 32 patients had a fracture line located in medial fifth of the clavicle, 20 patients were intra-articular fracture. Eighteen patents were fixed with a locking plate (7 inverted distal clavicle plate, 3 straight locking plate, 3 distal fibula plate and 5 T-plate), and the rest 16 patients were treated with a clavicle hook plate. With a mean follow up of 30.7±26.5 months, 33 patients had bone healing, the average Constant-Murley score was 90.9±11.0 points, the mean DASH score was 6.0±6.6 points, and the mean VAS was 0.4±1.1 points. Complications seen in 5 patients. Hook plate group showed a slightly better treatment outcomes than locking plate group in blood loss, shoulder flexion, Constant-Murley, DASH, VSA and complication rate, but with no statistical significance.

Conclusions: Both locking plates and hook plates can effectively treat displaced medial clavicle fractures. A locking plate is recommended when there is enough bone stock in the medial fragment for stable fixation, otherwise, if a medial clavicle fracture is too small, comminuted or has signs of sternoclavicular joint instability, a clavicle hook plate is recommended.