Limited incision plating of midshaft clavicle fractures: a case series of 1,038 patients.

Abstract

Clavicle fractures are a common injury in young and active patients. Nonoperative management has historically been preferred; however, recent studies have challenged this paradigm with evidence of lower nonunion rates and improved functional outcomes following surgical treatment. This article describes a limited incision approach to clavicle plating and reports long-term functional and radiographic outcomes for a large cohort of operative midshaft clavicle fractures. A prospectively maintained database was used to identify 1,038 patients who underwent surgical treatment for midshaft clavicle fractures. All operations were performed using a minimally invasive, 3-5 cm incision to expose, reduce, and plate the fracture, with retractors used to lever the skin and allow lateral and medial drilling. Clinical and radiographic follow-up included measurement of the Disabilities of the Arm, Shoulder and Hand score, patient-reported questionnaires, and serial X-rays until union. For 1,038 acute fractures treated surgically, the mean Disabilities of the Arm, Shoulder and Hand score at last follow-up was 0.8 (range: 0-46). Full range of shoulder movement was achieved in a mean time of 6.1 weeks (range: 1-52 weeks). The mean time to union was 10.6 weeks (range: 6-61 weeks) and the nonunion rate was 0.3%, in all cases due to infection. Deep and superficial infections occurred in 8 (0.6%) and 13 (1.3%) cases, respectively. Significant peri-clavicular numbness and plate irritation were rare (1.6% and 2.6%, respectively) and 94.3% of patients felt that their shoulder was 'normal' with a mean follow-up duration of 17.7 months (range: 39.0 days-79.2 months). In this large cohort with long-term follow-up, a limited incision approach for plating of acute midshaft clavicle fractures achieved good functional and radiographic outcomes with a low complication rate comparable to the reported rate for standard incision techniques.