PRIMARY STABILITY OF NAILING VERSUS LOW PROFILE DUAL PLATING OF MID-CLAVICULAR FRACTURES: A BIOMECHANICAL STUDY

Low-profile dual plating techniques have gained popularity for diaphyseal fractures due to their potential to reduce soft tissue irritation, thus decreasing the likelihood of implant removal. However, it has not yet been biomechanically investigated whether 2×2.0mm dual plating achieves stabilization comparable to a titanium elastic nail for clavicle midshaft fracture fixation. Twelve paired human cadaveric clavicles with simulated unstable diaphyseal shaft fractures (AO 15.2C) were stabilized with either an intramedullary nail (Group 1) or a combination of a superior and an anterior 2.0mm matrix mandible plate (Group 2). Specimens underwent initial quasistatic pure bending in superior-inferior and anterior-posterior direction, followed by cyclic superior-inferior load to failure. Interfragmentary movements were monitored by optical motion tracking. Dual plating demonstrated significantly higher initial construct stiffness in all bending directions and a reduced neutral zone compared to TEN nailing. In addition, fracture displacement amplitudes over all cycles were significantly higher in Group 1 versus Group 2 ( p = 0.002). The number of cycles to reach the test endpoint did not differ significantly between the groups ( p = 0.16), with Group 1 averaging 24420 cycles (SD 3615) and Group 2 averaging 28232 cycles (SD 5417). In selected patients with simpler unstable midshaft clavicle fractures, 2×2.0mm dual plating may offer effective biomechanical stability. However, large-gap C-type fractures remain too unstable for these methods, emphasizing the need for further research to refine indications and assess long-term outcomes.