Functional Outcomes of Displaced Midshaft Clavicular Fractures Treated with Precontoured Locked Plates: A Prospective Study.

Abstract

Background: This study assessed the functional outcomes and complications of open reduction and internal fixation (ORIF) using precontoured superior clavicle locking plates for displaced midshaft clavicular fractures.

Methods: In a prospective two-center study at Al-Thawra Modern General Hospital and Kuwait University Hospital, Sana'a, Yemen, from January 2018 to September 2024, 65 patients (≥18 years) with closed, displaced midshaft clavicular fractures (displacement >2 cm, shortening >2 cm, comminution, or skin tenting) underwent ORIF. Functional outcomes were evaluated six months postoperatively using the University of California, Los Angeles (UCLA) shoulder rating score. Data were analyzed using SPSS version 26.

Results: The mean patient age was 32.09 years (83.1% male, n=54). Road traffic accidents were the primary mechanism of injury (66.2%, n=43). At 6 months, the mean UCLA score was 32.46 ± 2.54, with 98.5% (n=64) achieving good or excellent outcomes (UCLA score ≥27) and 1.5% (n=1) fair/poor. Complications included hardware irritation (1.5%, n=1), hardware failure (3.1%, n=2), and superficial infections (1.5%, n=1). All patients (100%) reported satisfaction with their outcomes. The UCLA scores varied significantly according to injury mechanism, side, and age, with older patients showing lower scores.

Conclusion: ORIF with precontoured locked plates yielded promising functional outcomes, high patient satisfaction, and low complication rates. However, the observational design, lack of a control group, and 6-month follow-up limit broader conclusions. Larger controlled studies are needed to validate these findings and guide the optimal management of displaced midshaft clavicular fractures.