Medial Clavicle Osseous Dimensions with Implication on Plate Fixation.

ABSTRACT

Significantly displaced medial clavicle fractures are associated with high rates of painful nonunion. Operative fixation can be challenging due to limited medial bone stock and adjacent vital vascular structures. Twenty-one consecutive chest computer topography (CT) scans were analyzed to measure anterior-posterior and superior-inferior dimensions of the medial clavicle. Correlation between height and clavicular dimensions were assessed by Pearson correlation coefficient. Two cases using dual T-locking plates are described. From anterior to posterior, the medial clavicle typically measures 1.44 (SD 0.26 cm) and 2.51 cm (SD 0.38 cm) at its narrowest and widest points, respectively. The mean superior-inferior width was 1.56 cm (SD 0.21 cm) and 2.76 cm (SD 0.39 cm) at its narrowest and widest points, respectively. Inter-observer reliability was 0.986 with combined intra-observer reliability between two time points of 0.984. Surgeons may use CT to reliably evaluate the amount of bone available for screw purchase and pre-operatively determine expected screw lengths. Locking plates using both unicortical locking screws and bicortical screws can be used for fracture fixation. Both patients healed fractures with dual T-locking plates without a short-term hardware complication. Dual T-locking plates may be a consideration for medial clavicle fracture fixation when medial bone purchase is a concern.