Comparison of Surgical Treatment of Clavicle Fractures Using Superior and Anterior Plates: A Clinical Trial

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

10.22038/abjs.2025.84348.3837

Abstract

Objectives: Clavicle fractures are the most common injuries of the scapular girdle. These fractures can be treated surgically using two primary methods: open reduction with internal plate fixation or intramedullary fixation. Plate fixation can be performed in two commonly used positions: anterior and superior. This randomized, double-blind clinical trial aimed to compare the outcomes of superior versus anterior plate fixation in the treatment of clavicle fractures.
Methods: This randomized, double-blind clinical trial focused on patients with clavicle fractures who underwent internal plate fixation between 2020 and 2021. The patients were divided into two groups: the anterior group, which received internal plate fixation using an anterior-inferior plating technique, and the superior group, which received internal plate fixation using a superior plating technique.
Results: A total of 75 patients were included in this study, with an average age of 42.32 years in the anterior group and 40.92 years in the superior group. Sixty-three (84%) of the patients were male, and 39 (52%) of the patients sustained their fractures as a result of vehicle accidents. Patients in the anterior group reported a satisfaction score of 96.68 (±1.13), compared to 58.08 (±12.32) in the superior group (p<0.05). Ten (20%) patients in the superior group reported plate-related irritation after three months, while only four (16%) patients in the anterior group experienced irritation (p<0.05). Two patients in the superior group developed non-union and required re-surgery. No cases of infection or pneumothorax occurred due to the surgery. Out of the 75 patients included in the study, two in the superior group and one in the anterior group reported a loss of function at the three-month follow-up.
Conclusion: Anterior plating is usually correlated with higher rates of patient satisfaction.
        Level of evidence: I

Keywords

Main Subjects

References

  1. Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskelet Disord. 2017;18(1):82. doi: 10.1186/s12891-017-1444-1.
  2. Donnelly TD, MacFarlane RJ, Nagy MT, Ralte P, Waseem M. Fractures of the Clavicle: An Overview. Open Orthop J. 2013:7:329-33. doi: 10.2174/1874325001307010329.
  3. Nicholson J, Makaram N, Simpson A, Keating J. Fracture nonunion in long bones: A literature review of risk factors and surgical management. Injury. 2021:52 Suppl 2:S3-S11. doi: 10.1016/j.injury.2020.11.029.
  4. Twomey-Kozak J, Whitlock KG, O’Donnell JA, Klifto CS, Anakwenze O. Epidemiology of sports-related clavicle fractures in the United States: injuries from 2015 to 2019. Orthop J Sports Med. 2022;10(10):23259671221126553. doi: 10.1177/23259671221126553.
  5. Sahasrabhojanee AA, Mehendale AM, Gupta D, Gupta P, Kakar G. Malunion of a Clavicle Fracture in a Young Adult: A Case Report and Surgical Intervention. Cureus. 2023;15(11):e48202. doi: 10.7759/cureus.48202.
  6. Kotelnicki JJ, Bote HO, Mitts KG. The management of clavicle fractures. JAAPA. 2006;19(9):50, 53-4, 56. doi: 10.1097/01720610-200609000-00009.
  7. Jeray KJ. Acute midshaft clavicular fracture. J Am Acad Orthop Surg. 2007;15(4):239-48. doi: 10.5435/00124635-200704000-00007.
  8. Bentley TP, Hosseinzadeh S, eds. Clavicle fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
  9. Paladini P, Pellegrini A, Merolla G, Campi F, Porcellini G. Treatment of clavicle fractures. Transl Med UniSa. 2012:2:47-58.
  10. Rasmussen JV, Jensen SL, Petersen JB, Falstie-Jensen T, Lausten G, Olsen BS. A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients. Injury. 2011;42(4):414-7. doi: 10.1016/j.injury.2010.11.061.
  11. Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012;21(3):423-9. doi: 10.1016/j.jse.2011.08.053.
  12. Wang XH, Cheng L, Guo WJ, et al. Plate versus intramedullary fixation care of displaced midshaft clavicular fractures: a meta-analysis of prospective randomized controlled trials. Medicine (Baltimore). 2015;94(41):e1792. doi: 10.1097/MD.0000000000001792.
  13. Lenza M, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev. 2016;12(12):CD007121. doi: 10.1002/14651858.CD007121.pub4.
  14. Schemitsch LA, Schemitsch EH, Veillette C, Zdero R, McKee MD. Function plateaus by one year in patients with surgically treated displaced midshaft clavicle fractures. Clin Orthop Relat Res. 2011;469(12):3351-5. doi:10.1007/s11999-011-1915-x.
  15. Gao Y, Chen W, Liu YJ, Li X, Wang HL, Chen ZY. Plating versus intramedullary fixation for mid-shaft clavicle fractures: a systemic review and meta-analysis. PeerJ. 2016:4:e1540. doi: 10.7717/peerj.1540.
  16. Athiraj AM, Subramanian RM, Navaneetha S, Krishnan DS, Subash Y. Outcome analysis of plate versus intramedullary devices for mid shaft clavicle fractures. International Journal of Orthopaedics. 2023;9(3):114-8.
  17. Sharma V, Patil P, Gaonkar NK, Garud A, Choudhary S. A comparative study of stabilization of shaft clavicle fractures using intramedullary nailing vs plating. Int. J. Orthopaedics. 2019;5(2):6-13.
  18. Lenza M, Faloppa F. Surgical interventions for treating acute fractures or non‐union of the middle third of the clavicle. Cochrane Database Syst Rev. 2015;2015(5):CD007428. doi: 10.1002/14651858.CD007428.pub3.
  19. Raju GB, Ravish VN, Gowda BB. Surgical Treatment of Midshaft Clavicle Fractures with Intramedullary Titanium Elastic Nailing System. Journal of Orthopaedic Diseases and Traumatology. 2024;7(1):93-8.
  20. Sinha A, Edwin J, Sreeharsha B, Bhalaik V, Brownson P. A radiological study to define safe zones for drilling during plating of clavicle fractures. J Bone Joint Surg Br. 2011;93(9):1247-52. doi: 10.1302/0301-620X.93B9.25739.
  21. Hussey MM, Chen Y, Fajardo RA, Dutta AK. Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. J Orthop Trauma.2013;27(11):627-32. doi: 10.1097/BOT.0b013e31828c1e37.
  22. Wijdicks F-JG, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012;132(5):617-25. doi: 10.1007/s00402-011-1456-5.
  23. Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A. Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma. 2008;22(4):241-7. doi: 10.1097/BOT.0b013e31816c7bac.
  24. Favre P, Kloen P, Helfet DL, Werner CM. Superior versus anteroinferior plating of the clavicle: a finite element study. J Orthop Trauma. 2011;25(11):661-5. doi: 10.1097/BOT.0b013e3182143e06.
  25. Naveen B, Joshi G, Harikrishnan B. Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strategies Trauma Limb Reconstr. 2017;12(1):11-18. doi: 10.1007/s11751-016-0272-4.
  26. Jones CB, Sietsema DL, Ringler JR, Endres TJ, Hoffmann MF. Results of anterior-inferior 2.7-mm dynamic compression plate fixation of midshaft clavicular fractures. J Orthop Trauma. 2013;27(3):126-9. doi: 10.1097/BOT.0b013e318254883a.
  27. Buenter IR, Kremo V, Beeres FJP, et al. Does plate position influence the outcome in midshaft clavicular fractures? A multicenter analysis. Eur J Trauma Emerg Surg. 2024;50(3):1023-1031. doi: 10.1007/s00068-023-02400-y.
  28. Qin M, Zhao S, Guo W, et al. Open reduction and plate fixation compared with non-surgical treatment for displaced midshaft clavicle fracture: A meta-analysis of randomized clinical trials. Medicine (Baltimore). 2019;98(20):e15638. doi: 10.1097/MD.0000000000015638.
  29. Wiesel B, Nagda S, Mehta S, Churchill R. Management of Midshaft Clavicle Fractures in Adults. J Am Acad Orthop Surg. 2018;26(22):e468-e476. doi: 10.5435/JAAOS-D-17-00442.
  30. Sohn HS, Shon MS, Lee KH, Song SJ. Clinical comparison of two different plating methods in minimally invasive plate osteosynthesis for clavicular midshaft fractures: a randomized controlled trial. Injury. 2015;46(11):2230-8. doi: 10.1016/j.injury.2015.08.018.
  31. Nourian A, Dhaliwal S, Vangala S, Vezeridis PS. Midshaft fractures of the clavicle: a meta-analysis comparing surgical fixation using anteroinferior plating versus superior plating. J Orthop Trauma. 2017;31(9):461-467. doi: 10.1097/BOT.0000000000000936.
  32. Hulsmans MHJ, van Heijl M, Houwert RM, Timmers TK, van Olden G, Verleisdonk EJMM. Anteroinferior versus superior plating of clavicular fractures. J Shoulder Elbow Surg. 2016;25(3):448-54. doi: 10.1016/j.jse.2015.09.005.
  33. Favre P, Kloen P, Helfet DL, Werner CML. Superior versus Anteroinferior Plating of the Clavicle: A Finite Element Study. J Orthop Trauma. 2011;25(11):661-5. doi: 10.1097/BOT.0b013e3182143e06.
  34. Nourian A, Dhaliwal S, Vangala S, Vezeridis PS. Midshaft Fractures of the Clavicle: A Meta-analysis Comparing Surgical Fixation Using Anteroinferior Plating Versus Superior Plating. J Orthop Trauma. 2017;31(9):461-467. doi: 10.1097/BOT.0000000000000936.
  35. Serrano R, Borade A, Mir H, et al. Anterior-Inferior Plating Results in Fewer Secondary Interventions Compared to Superior Plating for Acute Displaced Midshaft Clavicle Fractures. J Orthop Trauma. 2017;31(9):468-471. doi: 10.1097/BOT.0000000000000856.
  36. Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Operative treatment of clavicle midshaft fractures: comparison between reconstruction plate and reconstruction locking compression plate. Clin Orthop Surg. 2010;2(3):154-9. doi: 10.4055/cios.2010.2.3.154.
  37. Formaini N, Taylor BC, Backes J, Bramwell TJ. Superior Versus Anteroinferior Plating of Clavicle Fractures. Orthopedics. 2013;36(7):e898-904. doi: 10.3928/01477447-20130624-20.
  38. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: A randomized clinical trial. J Shoulder Elbow Surg. 2010;19(6):783-9. doi: 10.1016/j.jse.2010.05.002.
  39. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10. doi: 10.2106/JBJS.F.00020.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 4
April 2026
Pages 285-294

Files

History

  • Receive Date: 01 December 2024
  • Revise Date: 13 October 2025
  • Accept Date: 20 July 2025

Share

How to cite

Statistics