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Clavicular Anatomy and the Applicability of Precontoured Plates
Jerry I. Huang, MD1; Paul Toogood, BS1; Michael R. Chen, MD1; John H. Wilber, MD1; Daniel R. Cooperman, MD1
1 Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University, 645 Hannah House, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address for J.I. Huang: orthojerr@yahoo.com
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the AO North America Resident Trauma Research Grant. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Oct 01;89(10):2260-2265. doi: 10.2106/JBJS.G.00111
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Background: Plate fixation of clavicular fractures is technically difficult because of the complex anatomy of the bone, with an S-shaped curvature and a cephalad-to-caudad bow. The purpose of the present study was to characterize variations in clavicular anatomy and to determine the clinical applicability of an anatomic precontoured clavicular plate designed for fracture fixation.

Methods: One hundred pairs of clavicles were analyzed. The location and magnitude of the superior clavicular bow were determined with use of a digitizer and modeling software. Axial radiographs were made of each clavicle and the precontoured Acumed Locking Clavicle Plate, which is designed to be applied superiorly. With use of Adobe Photoshop technology, the plates were freely translated and rotated along each clavicle to determine the quality of fit and the location of the "best fit."

Results: The location of the maximum superior bow was lateral, with a mean distance of 37.2 ± 18.4 mm from the acromial articulation and with a mean magnitude of 5.1 ± 5.9 mm. There was no significant difference in the location or magnitude of the apex of the bow between specimens from male and female donors. The anatomic precontoured clavicular plate had the best fit in specimens from black male donors and the worst fit in specimens from white female donors, with a poor fit being seen in 38% (nineteen) of the fifty specimensfrom white female donors. The best location for superior plate application was along the medial aspect of the clavicle.

Conclusions: The apex of the superior bow of the clavicle is typically located along the lateral aspect of the bone, whereas the medial aspect of the superior surface of the clavicle remains relatively flat, making it an ideal plating surface. The precontoured anatomic clavicular plate appears to fit the S-shaped curvature on the superior surface of the majority of clavicles in male patients but may not be as conforming in white female patients. While this plate fits in the medial three-fifths of the clavicle, it does not fit as well laterally.

Clinical Relevance: Recent studies have shown that displaced midshaft clavicular fractures that are treated with plate fixation have better functional outcomes than those that are treated nonoperatively. An understanding of clavicular anatomy is paramount for optimal plate design and fracture fixation. Our data provide potentially important information for future clavicular plate designs and applications.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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