Comparative analysis of functional outcome of anatomical precontoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures

Introduction: For the fixation of displaced midshaft clavicular fractures, different plates are available, each with its
specific pros and cons. The ideal plating choice remains subject to ongoing discussion. Reconstruction plates are cheap and
easily bendable, but their strength and stability have been questioned. The anatomical precontoured locking plates provide
better stability and strength compared with the reconstruction plate. Materials and methods: We have analyzed both
prospectively and retrospectively 55 cases of displaced midshaft clavicular fractures treated surgically using precontoured
anatomical locking plate (24 cases) or reconstruction plate (31 cases) for patients admitted in our institute between
January 2011 and December 2017. The clinical and radiological outcomes between the reconstruction plate and precontoured anatomical locking plate were compared using Quick Disability of the Arm, Shoulder and Hand (DASH) score
and plain radiographs, respectively. Results: The mean time to union was 16.3 weeks in the reconstruction plate group
compared with 13.4 weeks in the precontoured locking plate group. The mean score in Quick DASH was 32.65 in the
reconstruction group and 25.44 points in the precontoured locking plate group. We had complications such as hypertrophic scar, painful shoulder, and restricted range of motion in both the groups, whereas screw cutout and plate failure
were noted only in the reconstruction plate group, which needed implant removal. The mean follow-up period was
16.44 months (14–31 months). The removal of implant was carried out in three patients in the reconstruction group.
None of the group had nonunion. Conclusion: Surgical management of fresh middle third clavicle fractures with anatomical precontoured locking plate provided stable fixation, faster union, and better functional outcome compared with
the reconstruction plating. Anatomical plate had the advantage of less soft tissue stripping, and there is less need for lag
screw fixation of the plate for fracture stability as precontoured plate itself provides a rigid construct.