Surgical fixation of comminuted midshaft clavicle fractures using plate and screws demonstrates high union rates: study

Dr Supreeth  D R

Surgical fixation of comminuted midshaft clavicle fractures using plate and screws demonstrates high union rates: study

Written By : Dr Supreeth D R Published On 2025-11-21T21:30:33+05:30 | Updated On 21 Nov 2025 9:30 PM IST

Midshaft clavicle fractures are common, with comminuted variants posing a higher risk of non-union, often necessitating surgical intervention. Anatomical repair is critical due to the clavicle’s sole osseous connection between the shoulder and trunk, impacting functional outcomes.

The retrospective study by Sahil Kale et al evaluated 83 patients (74 males, nine females, aged 18–65 years) surgically treated for midshaft clavicle fractures. Dominant-side fractures accounted for 87% of cases. Severe comminution was managed using 2.7 mm cortical interfragmentary screws and the NISE knot technique with plating. Follow-up spanned 18 months, assessing clinical and radiological outcomes.

The key findings of the study were:

• The research comprised 83 patients who had surgery for 3- or 4- part midshaft clavicle fractures; the average age of patient’s was 43.5 (±4.6 years) (range-: 18–65 years).

• The research included 74 male patients and nine female individuals.

• The dominant side was affected in 87% of fractures.

• Patients regained near-complete shoulder motion within 3 weeks. Complications included visible deformity (n = 4), keloid formation (n = 3), scar hypoesthesia (n = 5), and one refracture with plate failure.

• No non-unions occurred, though two cases exhibited delayed union.

• Radiological and functional recovery was achieved in 97.6% of cases, with minimal long-term sequelae.

• Lateral lift-off was observed in two individuals due to varied clavicular curvatures.

• Two patients experienced delayed union, taking 4.5 months to show bony union.

The authors concluded – “Anatomical plating combined with interfragmentary screw fixation and the NISE knot approach results in good union rates and efficient restoration of clavicular length in comminuted midshaft clavicle fractures. This method can surgically address these fractures with good functional outcomes and high union rates. Future multicenter randomized controlled trials with a control group comparing traditional plating to the NISE knot approach and plating and longer follow-up periods are required to confirm these findings and provide more support for the NISE knot technique's superiority.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.