title: A prospective comparison between external fixation and plates for treatment of midshaft nonunions of the clavicle.
abstract: OBJECTIVE
  Several surgical techniques have been used to treat clavicular nonunions. The aim with this prospective study was to compare treatment of symptomatic midshaft clavicular nonunions with either external fixation or plating.
  
  
  METHODS
  The study included two consecutive series where the first 11 patients (8 men and 3 women) were treated with external fixation (EF) while the following 13 patients (5 men and 8 women) were treated with internal fixation using a 3.5 mm reconstruction plate (RP). All patients had autologous cancellous bone graft. After on average 8.6 years (EF) and 5.4 years (RP), respectively, an independent observer evaluated the patients.
  
  
  RESULTS
  In the EF-group 8/11 healed within 12 months while 3/11 healed after reoperation with a reconstruction plate and new bone grafting at 6-9 months. In the RP-group 12/13 healed within six months while 1/13 healed after two additional bone transplants. There was no hardware breakage. The healing time for the RP group was significant shorter when compared with the EF group even if the fractures that did not heal after the first operation were excluded. In 4 patients the plate was removed following healing. There was no significant difference in functional outcome between groups at follow up.
  
  
  CONCLUSIONS
  The reconstruction plate was a better alternative than external fixation due to faster and more reliable healing. Patients commonly considered the external frame cumbersome.
authors.affiliation: Department of Orthopaedics Uppsala University, Sweden. jan.nowak@skulderkliniken.se
authors.forename: J
authors.initials: J
authors.lastname: Nowak
authors.forename: H
authors.initials: H
authors.lastname: Rahme
authors.forename: M
authors.initials: M
authors.lastname: Holgersson
authors.forename: U
authors.initials: U
authors.lastname: Lindsjö
authors.forename: S
authors.initials: S
authors.lastname: Larsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries*; D016267:External Fixators; D005260:Female; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology