title: How well do contoured superior midshaft clavicle plates fit the clavicle? A cadaveric study.
abstract: BACKGROUND
  Given the degree of variation in clavicular morphology, 4 clavicle plating systems were examined for their congruity as superior, midshaft, anatomic clavicle (SMAC) plates in a cadaveric study.
  
  
  METHODS
  SMAC plates from 4 manufacturers were applied to 79 dry right human clavicles. Two systems offered multiple (4) variations of plates (MP), 1 offered two variations (TP), and 1 had a single plate (SP). Two examiners applied and clamped the best-fitting plate from each system onto each of the 79 clavicles and then graded them: 1, poor fit; 2, good fit; and 3, anatomic fit. Each examiner repeated the process to assess intraobserver and interobserver reliability. The scores were averaged to produce a final score for each system for each clavicle.
  
  
  RESULTS
  The MP systems scored the highest (32%-37% anatomic, 54%-63% good, 5%-8% poor), followed by the TP system (30% anatomic, 53% good, 17% poor), and finally the SP system (9% anatomic, 59% good, 32% poor). Of note, clavicular length significantly correlated with a higher degree of conformity in all plating systems (Spearman rank correlation P < .05 for each system). In clavicles longer than 150 mm, the MP and TP systems performed identically, with the SP system close behind. Contouring of the plate is needed in 73% of cases overall.
  
  
  CONCLUSIONS
  Plating systems with multiple plate shape variations are more advantageous when dealing with smaller-sized clavicles, typically in females. However, when dealing with larger clavicles, there was no real difference.
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK. Electronic address: amarmalhas@hotmail.com.
authors.forename: Amar M
authors.initials: AM
authors.lastname: Malhas
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK.
authors.forename: Yiannis G
authors.initials: YG
authors.lastname: Skarparis
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK.
authors.forename: Sankar
authors.initials: S
authors.lastname: Sripada
authors.affiliation: Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Soames
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK.
authors.forename: Arpit C
authors.initials: AC
authors.lastname: Jariwala
mesh_terms: D000328:Adult; D001860:Bone Plates; D002102:Cadaver; D002968:Clavicle / Q000033:anatomy & histology*; D018483:Diaphyses / Q000033:anatomy & histology; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012737:Sex Factors
keywords: Cadaveric; Clavicle; Fracture; Plate fixation; Shoulder; Trauma