Operative management of periarticular medial clavicle fractures—report of ten cases

Abstract BACKGROUND:: The periarticular medial clavicle fracture is a rare injury and can be treated conservatively in the majority of cases. However, up to 8% of the patients develop symptomatic nonunion, and fracture dislocation correlates with the number of poor functional results. Operative treatment may be beneficial in these cases. Studies with large series of operated patients are still missing. METHODS:: We investigated 10 patients with operative treatment of periarticular medial clavicle fractures. Preoperative X-ray or computed tomography scan was obtained, and follow-up assessment was performed at determined intervals, including physical examination and X-ray evaluation of bone healing. Finally, functional assessment was carried out from September 2009 to July 2010 using the Disabilities of the Arm, Shoulder and Hand score. RESULTS:: All operated patients had displaced periarticular medial clavicle fractures. A direct surgical approach was performed, and denudation of the bone fragments was avoided. In 8 of 10 cases, we used locking plates, preferentially the T-locking plate. In 6 of 10 patients, three screws were placed in the medial fragment or the sternum. The arm was immobilized in a sling for 2 weeks to 3 weeks, followed by careful passive and increasing active motion exercises. In 9 of 10 operated patients, we observed fracture healing and good functional results. Two patients with paraplegia/tetraplegia were excluded from final assessment but demonstrated fracture healing. In one case, we observed early material loosening caused by misused locking system and wound infection. CONCLUSIONS:: Operative treatment can be considered for periarticular, dislocated medial-end clavicle fractures. Computed tomography scan can be useful for operative planning and is mostly performed in patients with multiple injuries. Locking plates, such as the T-locking plate or the pilon reconstruction plate, are preferred devices. For rigid fixation, at least three locking screws should be placed in the medial bone fragment. The plate can be removed 18 months after osteosynthesis.