Displaced medial clavicle fractures: operative treatment with locking compression plate fixation

Objectives Medial clavicle fractures are rare injuries and historically treated non-operatively. Displaced medial clavicle fractures, however, have a higher incidence of delayed- or non-union compared to non- displaced medial clavicle fractures and might benefit from operative treatment. We describe below a new technique for treating intra-articular fractures or extra-articular fractures with a small medial fragment using special locking plates and present the results of our operatively treated patients. Methods First we describe our technique for treating very medial fractures with the radial (VA)-LCP (TM) Distal Humerus Plate (DePuy Synthes, Switzerland). Second, a retrospective cohort study was performed. All patients operated on for a displaced medial clavicle fracture between 2010 and 2017 were included. Primary outcome was the QuickDASH score and the Subjective Shoulder Value (SSV). Secondary outcomes were operative complications including mal- or non-union and implant removal. Results All 15 patients were available for follow-up. Fourteen patients were included in our analysis. One patient was excluded due to severe concomitant injuries. Six patients were treated with the radial (VA)-LCP (TM) Distal Humerus Plate, eight patients with the LCP (TM) Superior Anterior Clavicle Plate with lateral extension (DePuy Synthes, Switzerland) and one with a LCP 3.5 plate. The mean follow-up was 39 months (range 9-79). The mean QuickDASH score was 0.81 (range 0-4.50, SD +/- 1.44) and the mean SSV was 96 (range 80-100, SD +/- 6.53). One patient had an early revision operation and developed an infection after 1.5 years. No mal- or non-unions occurred. Eight patients had their implants removed. Conclusions Operative treatment of displaced medial clavicle fractures with well-fitting 'small fragment' locking plates provides an excellent long-term functional outcome. Intra-articular fractures or extra-articular fractures with a small medial fragment can be treated with the radial (VA)-LCP (TM) Distal Humerus Plate.