Using suture and locking anatomical bridging plate to fix comminuted mid-shaft clavicle fractures with intramedullary nail assistance in reduction.

BACKGROUND During conventional plate fixation of comminuted midshaft fracture of the clavicle, wedge-shaped fragments often need to be fixed with lag screws. A new procedure, which included intramedullary K-wire assistance in reduction, binding fragments by suture, and eventually bridging plate fixation, was compared with conventional techniques. HYPOTHESIS This new procedure is more effective than the conventional techniques, and the fixation of free fragments using lag screws is not necessary. MATERIAL AND METHODS This was a retrospective study of 60 patients from August 2008 to March 2013 with comminuted midshaft clavicular fractures with wedge-shaped fragments. Seventeen patients were treated with conventional plate fixation, and the wedge-shaped fragments were fixed using lag screws (LSPF). Another 43 patients were treated with the new procedure, including intramedullary K-wire assistance in reduction, binding of wedge-shaped fragments by suture, and bridging plate fixation (KSB). Patients were followed for an average of 13 months and radiographs were used to observe fracture healing. Shoulder function was assessed using the Constant Score System (CSS). RESULTS There was no significant difference in bone healing time and shoulder function between the two study groups. The operating time for KSB was significantly shorter than conventional LSPF (P=0.014). Fractures healed in 14.9±5.59 weeks for the conventional LSPF group and in 13.6±3.59 weeks for the KSB group. One patient treated with conventional LSPF had implant failure and underwent a second operation. CONCLUSIONS KSB is a simple and effective procedure for comminuted midshaft clavicular fractures. The wedge-shaped fragments in comminuted midshaft clavicular fractures do not always need to be fixed by lag screws and the new procedure described is an effective treatment alternative. LEVEL OF EVIDENCE Level IV.