Dispelling the fears of plating midclavicular fractures.

Eighteen midclavicular fractures treated by plate fixation were reviewed at an average follow-up of 39 months. The indications for surgery were gross displacement and comminution or shortening of greater than 15 mm. The fractures united in all cases within 2 to 4 months from the time of operation, without significant complications. Many orthopaedic surgeons are reluctant to internally fix midclavicular fractures even with gross displacement, citing operative treatment as a predisposing factor in the etiology of nonunions. It is now appreciated that malunion with shortening of midclavicular fractures, especially in young patients, is not benign. We recommend plate fixation for midclavicular fractures with gross displacement and comminution or shortening of greater than 15 mm. It is a safe procedure and does not predispose to nonunion if the principles of internal fixation are rigidly followed.