Functional Outcome of Unstable Mid Shaft Clavicle Fractures Treated with Pre-Contoured Anatomical Locking Plate: A Prospective Clinical Study

Background: Unstable displaced midshaft clavicle fractures are common injuries in young and active adults. Although nonoperative treatment remains appropriate for many clavicle fractures, substantial displacement, shortening and comminution have been associated with nonunion, symptomatic malunion and persistent functional impairment. Modern pre-contoured anatomical locking plates are designed to restore clavicular alignment while providing stable fixation and permitting early shoulder rehabilitation. The present study evaluated the clinical, radiological and functional outcome of unstable clavicle fractures treated with open reduction and internal fixation using a pre-contoured anatomical locking plate. Material and Methods: A prospective clinical study was conducted in the Department of Orthopaedics, in a tertiary care teaching hospital for a period of 18 months. Twenty-five adult patients with closed unstable displaced midshaft clavicle fractures were treated with open reduction and internal fixation using a 3.5-mm pre-contoured superior anatomical locking plate. Patients were followed clinically and radiologically at regular intervals. Fracture union, complications and functional outcome were assessed. Functional assessment was performed using the Constant-Murley shoulder score, comprising pain, activities of daily living, strength and range of motion. Results: The study reported right-sided fractures in 15 patients and left-sided fractures in 10. Road-traffic accidents were the predominant mechanism (19 patients), followed by accidental falls (6 patients). Eight fractures were Robinson type 2B1 and 17 were type 2B2. The reported time to union ranged from 10 to more than 18 weeks, with a mean of 12.76 weeks; 2 patients united at 10 weeks, 14 at 12–14 weeks, 6 at 16 weeks, 2 at 18 weeks and 1 after 18 weeks. Twenty-four patients achieved a satisfactory Constant score and one was unsatisfactory. Overall functional grading was excellent in 19 patients (76%), good in 5 (20%) and poor in 1 (4%). Complications included hardware prominence (2), screw pullout (2), deep infection (1), nonunion (1) and paresthesia (1). The deep infection occurred in a patient with uncontrolled diabetes and was followed by implant removal and eventual nonunion. Conclusion: In this institutional cohort, fixation of unstable midshaft clavicle fractures with a pre-contoured anatomical locking plate was associated with a high rate of fracture union and predominantly excellent or good functional outcomes. Stable anatomical reduction, appropriate plate positioning and protection of the supraclavicular nerves are important for minimizing complications. The results support anatomical locking plate fixation as an effective option for appropriately selected unstable displaced midshaft clavicle fractures, while emphasizing careful patient selection and optimization of comorbidities such as diabetes.

Keywords: Clavicle Fracture, Midshaft Fracture, Unstable Fracture, Pre-Contoured Plate, Locking Plate, Open Reduction and Internal Fixation, Constant-Murley Score, Fracture Union, Hardware Prominence.