Is plating of mid-shaft clavicular fractures possible with a conventional straight 3.5 millimeter locking compression plate?

Objective: Current literature describes improved clinical outcomes and a minor rate of pseudoarthrosis following operatively treated clavicular fractures. We investigated the feasibility of using a standard 3.5 mm AO locking compression plate (LCP) of adequate length for the stabilisation of mid-shaft fractures of the clavicle. Methods: The length and acromial and diaphyseal curvature depths were measured in 49 cadaveric clavicles. We then assessed how well the 6, 7, 8 and 9-hole plates fit on the clavicles. Results: The mean clavicular length was 155±12 mm, with a mean acromial curvature of 18.1± 3.7 mm and a mean diaphyseal curvature of 12 mm±4 mm. The optimum plate for the clavicle was a 7-hole LCP, providing adequate fixation in 48 of the 49 clavicles. Conclusion: The described technique for plate osteosynthesis of the clavicle with AO locking compression plate is feasible and results in a biomechanically strong construct for mid-shaft fractures. With the use of a locking plate, comminuted fractures may be bridged without a reduction in the strength of the construct.