title: Anteroinferior versus superior plating of clavicular fractures.
abstract: BACKGROUND
  Open reduction and plate fixation has gained recognition as an effective treatment for certain types of clavicular fractures. However, 88% of cases report some implant-related problems. To determine the optimal plate position, the aim of the present study was to compare implant-related irritation and proportion of plate removal in patients with clavicular fractures undergoing plate fixation by an anteroinferior or superior approach.
  
  
  METHODS
  Retrospectively collected data of 39 patients who underwent anteroinferior plating for displaced midshaft clavicular fractures were compared with prospectively collected data of 60 patients who were treated with superior plate fixation as part of a multicenter randomized controlled trial. Electronic medical records were reviewed for reports of complications, in particular, implant-related irritation and implant removal during follow-up. In addition, all patients were contacted in June 2014 to obtain additional information. The primary outcome parameter was implant-related irritation.
  
  
  RESULTS
  Univariate and multivariate regression analysis showed plate position was not significantly associated with implant-related irritation. Higher rates of asymptomatic patients with the plate still in place were observed in the anteroinferior group (46% vs 22%, P = .01). Almost an equal percentage of implant removals was seen in both groups because of implant irritation (36% vs 37%, P = .938).
  
  
  CONCLUSIONS
  The present study found the surgical approach of clavicular plating was not associated with implant-related irritation. Future studies are needed to determine whether there is an optimal approach for clavicle plating.
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands.
authors.forename: Martijn H J
authors.initials: MH
authors.lastname: Hulsmans
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van Heijl
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands.
authors.forename: R Marijn
authors.initials: RM
authors.lastname: Houwert
authors.affiliation: Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Tim K
authors.initials: TK
authors.lastname: Timmers
authors.affiliation: Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Ger
authors.initials: G
authors.lastname: van Olden
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands. Electronic address: ejverleisdonk@gmail.com.
authors.forename: Egbert Jan M M
authors.initials: EJ
authors.lastname: Verleisdonk
mesh_terms: D000328:Adult; D001860:Bone Plates / Q000009:adverse effects; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D020878:Device Removal; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Clavicular fracture; ORIF; anteroinferior; displaced; irritation; midshaft; plate fixation; superior