OBJECTIVES: To determine if a difference in plate position for fixation of acute, displaced, mid-shaft clavicle fractures would affect the rate of secondary intervention.

DESIGN: Retrospective Comparative Study

SETTING: two academic Level 1 Regional Trauma Centers

Patients: 510 patients treated surgically for an acutely displaced mid-shaft clavicle fracture between 2000-2013 were identified and reviewed retrospectively at a minimum of 24 months' follow-up (F/U). Fractures were divided into two cohorts, according to plate position: Anterior-Inferior (AI) or Superior (S). Exclusion criteria included age <16 years, incomplete data records, and loss to F/U. Group analysis included demographics (age, gender, BMI), fracture characteristics (mechanism of injury, open or closed), hand dominance, ipsilateral injuries, time between injury to surgery, time to radiographic union, length of F/U, and frequency of secondary procedures.

Intervention: Patients were treated either with AI or S clavicle plating at the treating surgeon's discretion.

Main Outcome Measures: Rate and reason for secondary intervention.

Statistical Analysis: Fisher's exact test, T-test and Odds Ratio were used for statistical analysis.

Results: Final analysis included 252 fractures/251 patients. 118 (47%) were in group AI; 134 (53%) were in group S. No differences in demographics, fracture characteristics, time to surgery, time to union, or length of F/U existed between groups. Seven patients/seven fractures (5.9%) in Group AI underwent a secondary surgery whereas 30 patients/30 fractures (22.3%) in group S required a secondary surgery. An additional intervention secondary to superior plate placement was highly statistically significant (P<0.001). Furthermore, because 80% of these subsequent interventions were a result of plate irritation with patient discomfort, the Odds Ratio for a second procedure was 5 times greater in those fractures treated with a superior plate.

Conclusions: This comparative analysis indicates that anterior-inferior plating of mid-shaft clavicle fractures appears to lessen clinical irritation and results in significantly fewer secondary interventions. Considering patient satisfaction and a reduced financial burden to the health care system, we recommend routine anterior-inferior plate application when ORIF of the clavicle is indicated.

Level of Evidence: Therapeutic level III

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