Are commercially-available precontoured anatomical clavicle plating systems offering the purported superior optimum fitting to the clavicle? A cadaveric analysis and review of literature.
PURPOSE
The indication for operative treatment of displaced midshaft clavicle fractures remains controversial. However, if plate fixation is considered, implant prominence and skin irritation are the most common causes for re-operation. Low profile implants as well as closely contouring plates to the individual anatomy may reduce these complications. The aim of this study was to compare the fitting accuracy and implant prominence of 3.5mm pelvic reconstruction plates (PRP) with pre-contoured anatomical clavicle plates (PACP) for midshaft clavicle fractures.


METHODS
Three-dimensional data of the largest, median and smallest male and female clavicle of an existing database of 89 cadaveric clavicles were included for analysis. A three-dimensional model of a commercially available PACP was used for digitally positioning of the plate on the segmented clavicles. Three-dimensional printouts of each clavicle were produced and the 3.5mm reconstruction plates were manually bent and positioned by the senior author. Computed tomography scans and three-dimensional reconstructions were then obtained to digitally compare the fitting accuracy and implant prominence.


RESULTS
Pelvic reconstruction plates offered superior fitting accuracy and lower implant prominence compared to PACP. The largest difference in implant prominence was observed in large sized female clavicles and measured 3.6mm.


CONCLUSION
Both, the less costly PRP plates and commercially available PACP for midshaft fractures of the clavicle demonstrated a clinically acceptable fitting accuracy. The manually bent pelvic-reconstruction plates demonstrated reduced implant prominence with superior fitting. Hypothetically this might contribute to a reduced rate of reoperation.


LEVEL OF EVIDENCE
Level IV cadaveric study.
['Bauer|D E|DE|', 'Hingsammer|A|A|', 'Schenk|P|P|', 'Vlachopoulos|L|L|', 'Imam|M A|MA|', 'Fürnstahl|P|P|', 'Meyer|D C|DC|']
D001860:Bone Plates D002102:Cadaver D002968:Clavicle D003198:Computer Simulation D018483:Diaphyses D005260:Female D005593:Fracture Fixation, Internal D050723:Fractures, Bone D006801:Humans D008297:Male D011474:Prosthesis Design D014057:Tomography, X-Ray Computed
Clavicle Midshaft Fracture Reconstruction plate Three-dimensional