title: Precontoured plating of clavicle fractures: decreased hardware-related complications?
abstract: BACKGROUND
  Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal.
  
  
  OBJECTIVE
  We compared the outcomes after precontoured and noncontoured superior plating of acute displaced midshaft clavicle fractures. Primary outcomes were rate of plate prominence, rate of hardware removal, and rate of complications. Secondary outcomes were ROM and pain and function scores.
  
  
  METHODS
  We retrospectively reviewed 52 patients with 52 acute, displaced midshaft clavicle fractures treated with either noncontoured or precontoured superior clavicle plate fixation. Fourteen patients with noncontoured plates and 28 with precontoured plates were available for followup at a minimum of 1 year postoperatively. Postoperative assessment included ROM, radiographs, and subjective scores including visual analog scale for pain, American Shoulder and Elbow Surgeons questionnaire, and Simple Shoulder Test.
  
  
  RESULTS
  Patients complained of prominent hardware in nine of 14 in the noncontoured group and nine of 28 in the precontoured group. Hardware removal rates were three of 14 in the noncontoured group and three of 28 in the precontoured group. Postoperative ROM and postoperative subjective scores were similar in the two groups.
  
  
  CONCLUSIONS
  Precontoured plating versus noncontoured plating of displaced midshaft clavicle fractures results in a lower rate of plate prominence in patients who do not undergo hardware removal.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Center for Shoulder, Elbow and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street PH 11, New York, NY 10032, USA.
authors.forename: Corinne
authors.initials: C
authors.lastname: VanBeek
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Boselli
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Cadet
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
authors.forename: William N
authors.initials: WN
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries*; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult