Surgical treatment of midclavicular fractures in the elderly: a comparison of locking and nonlocking plates.

Operative treatment of midclavicular fractures in patients older than 60 years poses an increased risk of fixation failure. Although plating of midclavicular fractures in the elderly is still a popular fixation method, osteopenic bone may result in plate loosening and fixation failure. The purpose of this study is to prospectively evaluate and compare the clinical outcomes of midclavicular fractures in patients older than 60 years who are treated with either a locking compression plate or nonlocking plate. Sixty-four elderly patients with midclavicular fractures were surgically treated with either a locking compression plate or nonlocking plate, which included dynamic compression plates and reconstruction plates. The locking compression plate group included 29 patients with an average age of 69.1 years. The nonlocking plate group included 35 patients with an average age of 66.3 years. Both groups were similar for age, gender, injury mechanism, fracture patterns, and confounding medical condition (P>.5). However, the locking compression plate group had lower complication rates compared to the nonlocking plate group (P=.087). In addition, the locking compression plate group had higher rates of return to work and exercise (P=.02, P=.016, respectively). If surgery of elderly patients with midclavicular fractures is indicated, internal fixation with a locking compression plate is preferable to a nonlocking plate.