title: Radiographic outcomes of single versus dual plate fixation of acute mid-shaft clavicle fractures.
abstract: BACKGROUND
  The clavicle exhibits considerable movement in three planes making rigid fixation challenging. The addition of a second plate may be considered to improve fixation rigidity, but risks compromising the blood supply to the fracture site. The purpose of this study is to assess if extraperiosteal dual plate fixation increases the rate of non-union, reoperation, and complications at 1 year for surgically treated acute mid-shaft clavicle fractures.
  
  
  METHODS
  Between June 1998 and June 2013, surgically treated mid-shaft clavicle fractures undergoing open reduction internal fixation within 4 weeks of injury were retrospectively reviewed. Patients undergoing single plate fixation were compared to dual plate fixation. Patients were followed for a minimum of 1 year. Charts were reviewed to assess union rates, reoperation, and complications.
  
  
  RESULTS
  One hundred and sixty-three clavicles (125 single plates, 34 dual plates) were evaluated. All patients (100%) in dual plating group and one hundred and fourteen (91%) in single plating group obtained bony union by 1 year (p = 0.13). Six patients (4.8%) experienced a non-union in the single plating cohort compared to the dual plating cohort who had a 100% union rate. Seven patients required reoperation in the single plate cohort due to implant failure (N = 4), infection (N = 2), and non-union (N = 1).
  
  
  CONCLUSIONS
  This limited series of patients demonstrates dual plate fixation is a reliable option for acute mid-shaft clavicle fractures, with excellent union rates and low complication rates. Compared to single plate fixation, no significant differences in outcomes were identified. In the case of more complex fracture patterns, application of a second extraperiosteal plate may be utilized without compromising healing or increasing complication rates.
authors.affiliation: Institute of Orthopaedics, Chinese PLA, Beijing Army General Hospital, Beijing, China.|Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Shannon
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. torchia.michael@mayo.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Torchia
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.|Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: Bradley
authors.identifier: http://orcid.org/0000-0002-9355-5069
authors.initials: B
authors.lastname: Schoch
mesh_terms: D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D000070799:Open Fracture Reduction / Q000379:methods*; D012189:Retrospective Studies
keywords: Clavicle fracture; Dual plate; Dual plate construct; Provisional fixation; Trauma; Union