RESEARCH Morphologic Study of the Midshaft Clavicle
Clavicle fractures occur relatively frequently, representing up to five percent of all fractures and 44 percent of those in the shoulder girdle. Eighty percent of clavicular fractures in adults occur in the middle one-third of the bone.5
Operative plate fixation of displaced midshaft clavicle fractures has been shown to improve the functional outcomes and decrease the likelihood of non-union over non-surgical techniques. One study showed that the risk of nonunion after plating was 2.5 percent, which was significantly lower compared to 5.9 percent for the non-operative treatment. For displaced fractures, the risk of nonunion after plating was 2.2 percent, which was significantly lower compared to 15.1 percent for non-operative treatment.6
Recent studies have demonstrated that precontoured anatomic plates have not been as conforming in certain patients.2,3 The use of shorter and straighter plates with less cortices (two on each side of the fracture instead of three) seem to have better outcomes in midshaft clavicle fracture repair. However, no studies have been conducted to investigate the average length and subtle contours of this segment of the clavicle in order to design the ideal plate.
The purpose of this study was to characterize the morphology of the straight midshaft segment of the clavicle to examine the potential for using shorter, straight superior plates that could ultimately improve treatment, reduce surgical morbidity and cost.
Recent studies have shown that operative plate fixation of displaced midshaft clavicular fractures demonstrate better functional outcomes than those that are treated nonoperatively. Furthermore, the use of shorter plates with fewer screws has the potential to decrease surgical morbidity, time and cost as it relates to less surgical exposure and drill holes, as well as potentially allowing for a smaller plate inventory and less technical difficulty in applying a shorter straight plate to the midshaft clavicle fracture.
Understanding clavicular anatomy is important for better plate design and fixation. Using 3-D modeling we were able to characterize the length and radius of curvature of the clavicle straight segment. Our data provides potentially important information for the design of shorter, more anatomic plates that could decrease the length of surgical exposure, cost and morbidity associated with superior plating of midshaft fractures of the clavicle.