Displaced medial clavicle fractures: operative treatment with locking compression plate fixation

Objectives: Medial clavicle fractures are rare injuries and historically treated non-operatively. Displaced medial clavicle fractures, however, have a higher incidence of delayed- or non-union compared to non- displaced medial clavicle fractures and might benefit from operative treatment. We describe below a new technique for treating intra-articular fractures or extra-articular fractures with a small medial fragment using special locking plates and present the results of our operatively treated patients. Methods: First we describe our technique for treating very medial fractures with the radial (VA)-LCP™ Distal Humerus Plate (DePuy Synthes, Switzerland). Second, a retrospective cohort study was performed. All patients operated on for a displaced medial clavicle fracture between 2010 and 2017 were included. Primary outcome was the QuickDASH score and the Subjective Shoulder Value (SSV). Secondary outcomes were operative complications including mal- or non-union and implant removal. Results: All 15 patients were available for follow-up. Fourteen patients were included in our analysis. One patient was excluded due to severe concomitant injuries. Six patients were treated with the radial (VA)-LCP™ Distal Humerus Plate, eight patients with the LCP™ Superior Anterior Clavicle Plate with lateral extension (DePuy Synthes, Switzerland) and one with a LCP 3.5 plate. The mean follow-up was 39 months (range 9–79). The mean QuickDASH score was 0.81 (range 0–4.50, SD ± 1.44) and the mean SSV was 96 (range 80–100, SD ± 6.53). One patient had an early revision operation and developed an infection after 1.5 years. No mal- or non-unions occurred. Eight patients had their implants removed. Conclusions: Operative treatment of displaced medial clavicle fractures with well-fitting ‘small fragment’ locking plates provides an excellent long-term functional outcome. Intra-articular fractures or extra-articular fractures with a small medial fragment can be treated with the radial (VA)-LCP™ Distal Humerus Plate.