Dual-plating is associated with lower implant removal rates compared with single-plate fixation for midshaft clavicle fractures: a meta-analysis.

Abstract

Displaced midshaft clavicle fractures are often managed operatively, with single-plate fixation serving as the standard approach. Dual-plate fixation has emerged as an alternative, particularly for complex fracture patterns, aiming to reduce hardware-related complications and enhance biomechanical stability. The aim of this study was to compare outcomes and complications following single and dual-plating techniques for midshaft clavicle fractures. A systematic literature search was performed using PubMed, Scopus, Embase, and Google Scholar through July 20, 2025. Comparative studies evaluating dual- versus single-plate fixation for midshaft clavicle fractures in adults were included. Seven studies met inclusion criteria, including 825 patients with midshaft clavicle fractures. Outcomes assessed included operative time, the American Shoulder and Elbow Surgeons (ASES) score, nonunion rates, other complication rates, implant removal rates, and overall reoperation rates. Dual-plate fixation was associated with significantly lower implant removal rates (risk ratio (RR) = 2.58; 95% CI: 1.45-4.57; p = 0.001) and overall reoperation rates (RR = 2.94; 95% CI: 1.47-5.87; p = 0.002) compared to single-plate fixation. Additionally, a borderline statistically significant reduction in other complications was observed with dual plating (RR = 1.95; 95% CI: 1.01-3.80; p = 0.05), with complication rates of 7.0% versus 19.4%, respectively. No statistically significant differences were found in operative time, ASES scores, or nonunion rates (all p ≥ 0.05). Dual-plate fixation is associated with significantly lower rates of implant removal and reoperations, and a borderline but clinically significant reduction in other complications, compared with single-plate fixation for midshaft clavicle fractures. These findings suggest that dual plating may offer improved implant-related outcomes without increasing operative time or compromising fracture healing.