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Medial Clavicle Osseous Dimensions With Implication on Plate Fixation

Grantham, William J., MD; Halverson, Schuyler J., MD; Lee, Donald H., MD

Techniques in Shoulder & Elbow Surgery: March 2019 - Volume 20 - Issue 1 - p 26–29
doi: 10.1097/BTE.0000000000000152
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Significantly displaced medial clavicle fractures are associated with high rates of painful nonunion. Operative fixation can be challenging due to limited medial bone stock and adjacent vital vascular structures. In total, 21 consecutive chest computer tomographic scans were analyzed to measure anterior-posterior and superior-inferior dimensions of the medial clavicle. Correlation between height and clavicular dimensions were assessed by the Pearson correlation coefficient. Two cases using dual T-locking plates are described. From anterior to posterior, the medial clavicle typically measures 1.44 (SD, 0.26 cm) and 2.51 cm (SD, 0.38 cm) at its narrowest and widest points, respectively. The mean superior-inferior width was 1.56 cm (SD, 0.21 cm) and 2.76 cm (SD, 0.39 cm) at its narrowest and widest points, respectively. Interobserver reliability was 0.986 with combined intraobserver reliability between 2 timepoints of 0.984. Surgeons may use computer tomography to reliably evaluate the amount of bone available for screw purchase and preoperatively determine expected screw lengths. Locking plates using both unicortical locking screws and bicortical screws can be used for fracture fixation. Both patients healed fractures with dual T-locking plates without a short-term hardware complication. Dual T-locking plates may be a consideration for medial clavicle fracture fixation when medial bone purchase is a concern.

Vanderbilt Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN

IRB exemption and approval obtained from Vanderbilt University Institutional Review Board (IRB #151369, 161500).

Supported by UL1TR000445 from NCATS (National Center for Advancing Translational Sciences)/NIH (National Institutes of Health) for utilization of REDCap (Research Electronic Data Capture).

The authors declare no conflict of interest.

Reprints: Donald H. Lee, MD, 1215, 21st Avenue South, Suite 3200, Nashville, TN 37232 (e-mail: donald.h.lee@vanderbilt.edu).

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