Mini-screws assisted plate fixation for comminuted midshaft clavicular fractures: A retrospective study

Purpose To introduce an unconventional surgical technique using mini-screws combined with plate fixation for the treatment of comminuted midshaft clavicular fractures (CMCFs), and to compare the clinical outcomes between precontoured locking plates and reconstruction plates. Methods A retrospective study was performed on 94 patients with CMCFs who underwent surgical fixation with 2.0 mm mini-screws combined with either precontoured locking plates (61 patients) or reconstruction plates (33 patients) from January 2020 to December 2023. The primary outcome measures included bone union rate, fracture healing time, DASH score, and related complications, particularly plate-related skin irritation. Results After a mean follow-up of 14 months (range, 6–21 months), all fractures achieved bony union without any internal fixation failure or malunion. There were no significant differences in fracture healing time (p = 0.49), DASH scores at 6 weeks (p = 0.38) and 12 months (p = 0.26) between the precontoured locking plate group and the reconstruction plate group. The incidence of skin irritation was higher in the precontoured locking plate group (18%) than in the reconstruction plate group (9.1%), but the difference was not statistically significant. Conclusion Mini-screws assisted plate fixation with either precontoured locking plates or reconstruction plates is an optimal surgical technique for CMCFs, achieving stable fixation and a high bony union rate via preservation of the fragments' periosteum and blood supply—the core principle of this approach. Plate selection should be individualized based on clavicular morphology to ensure optimal fitting.