Clinical and radiological comparison of single and double-plate fixation in comminuted clavicular shaft fractures

Aim: In this study, we compared the single-plate technique (with suturing of small fragments) and the double-plate technique, that we applied to patients who underwent surgery for comminuted clavicle fractures, in terms of fracture healing, early return to work, and the need for secondary surgery due to plate irritation. Materials and Methods: All patients who underwent surgery due to clavicle fracture between 2018 and 2023 were evaluated retrospectively. A total of 107 patients who came for regular check-ups and were under our follow-up were evaluated. Fifteen patients with comminuted shaft fractures who were fixed with a 3.5 mm plate superiorly and a 2.4 mm mini plate anteriorly, and 19 patients who were fixed with a 3.5 mm single-plate superiorly and 2.0 Ethibond sutures, were included in the study. Patients were divided into two groups according to single/double-plate application. Patients in Group 1 received a 3.5 mm Locking Compression Plate (LCP) single-plate application superiorly followed by a doubled-suture Nice knot (described by Boileau et al.) (Figure 1). In Group 2, patients received a superior 3.5 mm LCP plate followed by an anterior 2.4 mm mini plate (Figure 2). Results: Significant differences were observed between patients with single-plate and double-plate applications in terms of various clinical recovery times, return to work times, and plate removal requirements. The clinical recovery time was significantly faster in the double-plate group [6 (IQR: 5-7) weeks vs. 4 (IQR: 4-5) weeks, p < 0.001]. The time to return to work was similarly shorter in the double-plate group [8 (IQR: 7-8) weeks vs. 7 (IQR: 6-7) weeks, p = 0.001]. The need for plate removal was significantly higher in the double-plate group (p = 0.016), with 73.3% (n=11/15) of patients requiring plate removal, compared to 31.6% (n=6/19) in the single-plate group. Conclusion: In addition to superior plating in the fixation of comminuted clavicle fractures, the application of a mini plate from the anterior for fixation of the butterfly fragment allows for earlier rehabilitation and a rapid return to work. However, the risk of a second operation due to plate irritation should also be considered. No negative effect of fixation of small fragments with sutures on fracture union was observed. If the situation of the soft tissue is not well, a single-plate can be used in comminuted fractures. However, in cases where fixation is not enough, double-plate is a procedure that can be applied safely.