3D Clavicular Reconstruction Plates Offer Better Surgical Results

A new study demonstrates that three-dimensional (3D) reconstruction plates for displaced midshaft fractures of the clavicle offer better outcomes than plates fixed onto the superior surface.

Researchers at Zhejiang Province Traditional Chinese Medicine (TCM) Hospital (Hangzhou, China) conducted a randomized study that compared outcomes in 133 consecutive patients (mean age of 44.2 years) with displaced midshaft fractures of the clavicle that were allocated randomly to either a 3D (67 patients) or superior open reduction and fixation by a reconstruction plate (66 patients). Outcome measures included the perioperative outcome index, delayed union, revision surgery, and symptoms beyond 16 weeks. Computerized tomography (CT) was used to reconstruct an image of each affected clavicle and Photoshop software was employed to calculate the percentage of the clavicular cortical area in the sagittal plane. The patients were reviewed clinically and radiographically at 4 and 12 months after the operation.

The study results showed that the superior plate group had a higher rate of delayed union and had more symptomatic patients than the 3D group; the researchers found that 94% of patients from the 3D group demonstrated healing of the fractures in comparison with just 65% in the superior group. The percentage comparisons of cortical bone area obtained via the CT scans demonstrated that the cortical bone was thicker in the superior distal segment than in the inferior segment, and was also thicker in the anterior mid-section than in the posterior. The study was published in the November 2008 issue of The Journal of Bone and Joint Surgery - British Volume.

"Because of the complex morphology and functional anatomy of the clavicle, a superior plate cannot completely limit displacement, whereas a 3D fixation can better adapt to natural stresses in the bone,” concluded lead author orthopedic surgeon J.-W. Shen, M.D., and colleagues of the department of orthopedic and traumatic surgery. "If fixation of midshaft fractures of the clavicle with a plate is indicated, a 3D reconstruction plate is better than one placed superiorly, because it is consistent with the stress distribution and shape of the clavicle.”

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Zhejiang Province Traditional Chinese Medicine (TCM) Hospital