Clavicle fractures. Reducing the cost of the implant. The use of reconstruction 3.5 mm plates

There is a trend towards operative fixation of shortened and displaced clavicular fractures in high demand young patients.  In the past most fractures of the clavicle were treated with sling immobilization and most orthopaedic surgeons will quote: "The rate of nonunion even for displaced fractures was 0.9%". The debate about these fractures is that it is not important to demonstrate radiographic healing as it was demonstrated in the past. It is also of equal importance to demonstrate that active young patients with malunions returned to their previous job (construction etc) or sports without problems. Studies today show that fragment displacement of more than 100% and shortnening > 2 cm may lead to 30% loss of strength to the shoulder. It is important to let active patients now about the functional limitations if they elect not to have surgery.

Due to the changes in the indications for surgery there is a variety of implants in the market today offering locking screws and "anatomically" contoured plates for fixation of the fracture. In our experience these plates are (1) expesive $$$ (2) The fall into the category "one size fits none". In other words they do not provide what they promise ie fitting to the shape of clavicle.

The following case demonstrates the use of a standard 3.5 reconstruction plate that was contoured at the time of surgery to fit the patient's anatomy. We prefer the use of such a plate if the bone is not osteopenic and there is no need for locking screws. It reduces the cost of surgery and provides easier application without compromise of the reduction (pull of the fragments to the shape of the plate and loss of fixation at the time of screw fixation through the plate)

This a 30 y/o car mechanic who works "under the cars" with the shoulder in forward elevation for 8-10 hours a day. He presented with a shortened and displaced clavicular fracture after an ATV injury. Fixation was performed with a 3.5mm reconstruction plate. He healed without complications and went back to his job at 4 months postoperatively. He was released to full duty at 6 months without restrictions and was advised not to have the plate removed due to the risk of fracture through the screw holes.