Anteroinferior versus superior plating techniques for displaced midshaft clavicle fractures: A retrospective single centre cohort study from Northern Nigeria

Background: Clavicle fractures are common injuries accounting for up to 5% of all fractures in adults. Most clavicle fractures heal well with nonoperative treatment, some however, require surgical intervention especially when they are displaced. While plating remains the most popular and most successful method of clavicle fixation; the optimal position of the plate is yet to be agreed upon. Purposes: The purpose of this study was to compare the functional outcomes of displaced clavicle fractures fixed with superior and anteroinferior plating techniques. Patients and methods: This retrospective cohort study of 69 patients (45 males and 24 females) was carried out between January 2014 and December 2018 at a government orthopaedic hospital in north-western part of Nigeria. The study involved all consecutive patients who sustained a displaced mid-shaft clavicle fracture and had open reduction and internal fixation (ORIF) with either superior plating (SP) or anterior-inferior plating (AIP) and were followed up for at least one year. Data analyzed include: age, sex, laterality, mode of injury, the time from initial injury to surgery, type of plate used, position of the plate, union rate, functional outcome and peri-operative complications. Results: Fourty-two patients had SP and twenty seven patients had AIP. Fourty one (97.6%) patients had fracture union in SP group while all the twenty seven patients (100%) in the AIP group had fracture union. The mean QuickDASH scores was 3.2 ± 4.6 and 3.6 ± 4.7 in AIP and SP groups respectively. There was no significant difference in the union rates and functional outcome between the two groups. Conclusion: Both superior and anteroinferior plating techniques are safe and effective in the surgical management of displaced mid-clavicle fractures. Level of evidence: Level 3, retrospective cohort study.