title: Dual mini-fragment plating for midshaft clavicle fractures: a clinical and biomechanical investigation.
abstract: BACKGROUND
  We sought to evaluate clinical and biomechanical outcomes of dual mini-fragment plate fixation for clavicle fractures. We hypothesized that this technique would produce an anatomical reduction with good clinical outcomes, be well tolerated by patients, and demonstrate equivalent biomechanics to single plating.
  
  
  METHODS
  Dual mini-fragment plating was performed for 17 isolated, displaced midshaft clavicle fractures. Functional outcomes and complications were retrospectively reviewed. A sawbones model compared dual plating biomechanics to a (1) superior 3.5-mm locking reconstruction plate, or (2) antero-inferior 3.5-mm locking reconstruction plate.
  
  
  RESULTS
  On biomechanical testing, with anterior loading, dual plating was significantly more rigid than single locked anterior-plating (p = 0.02) but less rigid than single locked superior-plating (p = 0.001). With superior loading, dual plating trended toward higher rigidity versus single locked superior-plating (p = 0.07) but was less rigid than single locked anterior-plating (p = 0.03). No statistically significant differences in axial loading (p = 0.27) or torsion (p = 0.23) were detected. Average patient follow-up was 16.1 months (12-38). Anatomic reduction was achieved and maintained through final healing (average 14.7 weeks). No patient underwent hardware removal. Average 1-year DASH score was 4.0 (completed in 88 %).
  
  
  CONCLUSIONS
  Displaced midshaft clavicle fractures can be effectively managed with dual mini-fragment plating. This technique results in high union rates and excellent clinical outcomes. Compared to single plating, dual plating is biomechanically equivalent in axial loading and torsion, yet offers better multi-planar bending stiffness despite the use of smaller plates. This technique may decrease the need for secondary surgery due to implant prominence and may aid in fracture reduction by buttressing butterfly fragments in two planes.
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Prasarn
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Meyers
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Wilkin
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA. helfetd@hss.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Wellman
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Chan
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Jaimo
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
mesh_terms: D001134:Arm Injuries / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D012189:Retrospective Studies
keywords: Biomechanics; Clavicle; DASH; Dual plating; Fixation; Fracture; Functional outcomes