Locking plate fixation of mid-shaft clavicle fractures: analysis of complications, reoperation rates and functional outcome

Abstract

Introduction: Clavicle fractures account for about 5-10% of all fractures and most of these fractures are located in the middle third of clavicle. Traditionally, these fractures have been treated by conservative methods. In recent years, surgical fixation of these fractures is becoming a prefered method of treatment and locking plate fixation is a commonly used mode of osteosynthesis. However, the functional results and complications of locking plate fixation documented in the literature are not clear and often conflicting. So the aim of this study is to analyse the results of locking plate osteosynthesis of mid-shaft clavicle fractures. Objective: To study complications, reoperation rates and functional outcome of clavicle fractures treated with locking plate osteosynthesis. Methods: Sixty Seven cases of mid-shaft clavicle fractures who underwent locking plate fixation in our orthopaedic department from January 2013 to December 2016 were identified. Those patients who attended regular follow-up and had recorded Constant-Murley Scores (CMS) were included. Seven patients who did not attend regular follow-up or had incomplete records were excluded from analysis. The study group comprising 60 patients were analysed for complications and functional outcome by studying patient records and x-rays. Results: There was one case of failure of fixation with non-union and 8 patients had their plate removed for discomfort. Overall, there were 92 % excellent to good, 5% fair and 3% poor results. There were no cases of infection. Conclusion: The locking plate osteosynthesis gives good to excellent functional outcome in most of the patients. It helps with early mobilisation and prevents shoulder stiffness. The overall rate of implant failure and non-union after plate fixation is low. The necessity of removal of implant in significant number of patients should be kept in mind.