Does butterfly fragment management affect healing following fixation of comminuted clavicle fractures?

Evaluate healing outcomes of patients who sustained a comminuted clavicle fracture and underwent operative fixation using a bridge plate technique or interfragmentary screw/neutralization plate.

Two hundred and seventy-one comminuted clavicle fractures that underwent operative fixation with minimum 6 months follow-up were retrospectively reviewed. Patients were grouped based on fixation methods. Data collected include patient demographics and injury information. Fracture healing, total complications, fracture related infection, removal of hardware, nonunion, and revision fracture surgery were reviewed. Clinical healing was defined as non-tenderness about the fracture site, and radiographic healing was defined as bridging callus and/ or lack of fracture line on X-ray. Chi square analysis, T test, and linear regression were used for analysis.

There were 126 comminuted fractures fixed with a bridge plate and 145 comminuted fractures fixed with a plate and at least one interfragmentary screw both with a mean follow-up of 8.2 months. The bridge plated group was more female, the result of high-energy mechanisms, and had more anteroinferior plates (p < 0.05 for all). There were no differences in time to radiographic healing as well as incidence of nonunion between cohorts. Patients fixed with the bridge plate technique underwent a higher incidence of revision surgery, higher incidence of hardware removal, and had a longer time until clinically healed. On multivariate regression analysis, fixation method was not associated with any of these outcomes (p < 0.05 for all).

Bridge plating and lag screw/neutralization plate fixation were both associated with similar rates of healing. Complication profiles were similar.