Unicortical versus bicortical plate fixation for midshaft clavicular fractures

Abstract

Background: The aim of this study was to compare the functional and radiological outcomes of unicortical vsbicortical fixation in patients with midshaft clavicular fractures who were treated using pre-contoured lockingplates.Methods: We performed a prospective multicenter study of 45 individuals who underwent open reduction andinternal fixation of midshaft clavicular fractures with precontoured locking plates between March 2017 andDecember 2019. Twenty-five patients were treated with bicortical screws and 20 patients with unicorticalscrews. Functional outcomes were assessed at 6 months and 12 months after surgery using the Constant score, the11-item version of the Disabilities of Arm, Shoulder and Hand (Quick- DASH) score and the Single AssessmentNumeric Evaluation (SANE) score. Pain was evaluated using a visual analog scale (VAS). The rate of return towork and sports was also recorded. Radiologic evaluation was obtained in the immediate postoperative day,monthly until fracture consolidation, at 6 months and 12 months. All intraoperative and postoperative complicationswere documented.Results: At both 6 and 12 months, the follow-up rates were 100%, and the mean age was 28.5 years (range, 20 to45 years). The mean postoperative Constant score, Quick DASH, and SANE score at 12 months were 93.5 (±6),2.3 (±3), and 92% (±7), respectively. There were no significant differences in the functional scores between thegroups neither at 6 months nor at 12 months. Of the 30 active workers, 97% were able to return to their previousworking routine and from the 25 patients who practiced sports before the injury,92% returned to sports all at thesame level. All the fractures healed in both groups. There were 6 complications (13%).Conclusion: In young, active patients with displaced midshaft clavicular fractures, both unicortical and bicorticallocked plates achieved 100% bone consolidation, with excellent functional outcomes and a low rate of complicationswithout significant differences between the groups. Therefore, locked plates with unicortical fixationcould be a very good alternative for the management of young patients with midshaft clavicular fractures,potentially avoiding severe neurovascular complications.Level of evidence: Prospective comparative (Level II)