{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:05:48Z","timestamp":1792098348542,"version":"4.4.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Luzern"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Low-profile dual plating techniques have gained popularity for diaphyseal clavicula fractures due to their potential to reduce soft tissue irritation. Intramedullary nailing is also an established surgical option for treatment of diaphyseal clavicle fractures. The present study therefore aimed to evaluate whether a 2\u2009\u00d7\u20092.0\u00a0mm dual plating system can achieve biomechanical performance comparable to intramedullary nailing while reducing implant-related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>Twelve paired human cadaveric clavicles with simulated unstable diaphyseal shaft fractures AO\/OTA 15.2\u00a0C were stabilized via elastic nailing (Group 1) or dual plating using a superior and an anterior 2.0\u00a0mm plate (Group 2). Specimens underwent biomechanical testing with initial quasistatic superior-inferior and anterior-posterior bending, followed by cyclic superior-inferior loading to failure. Interfragmentary movements were monitored by optical motion tracking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Dual plating demonstrated significantly higher initial construct stiffness in all bending directions and a reduced neutral zone compared to intramedullary nailing (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.016). In addition, fracture displacement amplitudes over all cycles were significantly higher in Group 1 versus Group 2 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). The number of cycles required to reach the test endpoint at a 45\u00a0mm displacement did not differ significantly between the groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.160), with Group 1 averaging 24,420 cycles (SD\u2009\u00b1\u20093,615) and Group 2 averaging 28,232 cycles (SD\u2009\u00b1\u20095,417).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low-profile dual plating may offer improved initial stability of midshaft clavicle fractures without compromising their long-term performance, making it a promising alternative to elastic nailing. In selected patients with simpler unstable midshaft clavicle fractures, 2\u2009\u00d7\u20092.0\u00a0mm dual plating may offer effective biomechanical stability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-025-02854-2","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T06:54:25Z","timestamp":1745909665000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Primary stability of nailing versus low-profile dual plating of mid-clavicular fractures\u2013 a biomechanical cadaveric study"],"prefix":"10.1007","volume":"51","author":[{"given":"Fabian","family":"Pretz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J. P.","family":"Beeres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn-Christian","family":"Link","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reto","family":"Babst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannic","family":"Lecoultre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Varga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Pastor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J. M. van de","family":"Wall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"issue":"Suppl 5","key":"2854_CR1","doi-asserted-by":"publisher","first-page":"110818","DOI":"10.1016\/j.injury.2023.05.049","volume":"54","author":"C von R\u00fcden","year":"2023","unstructured":"von R\u00fcden C, Rehme-R\u00f6hrl J, Augat P, Friederichs J, Hackl S, Stuby F, et al. Evidence on treatment of clavicle fractures. Injury. 2023;54(Suppl 5):110818.","journal-title":"Injury"},{"issue":"12","key":"2854_CR2","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1016\/j.injury.2013.09.006","volume":"44","author":"TT Huttunen","year":"2013","unstructured":"Huttunen TT, Kannus P, Lepola V, Pihlajam\u00e4ki H, Mattila VM. Surgical treatment of clavicular fractures in Finland - A register based study between 1987 and 2010. Injury. 2013;44(12):1899\u2013903.","journal-title":"Injury"},{"issue":"16","key":"2854_CR3","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.2106\/JBJS.16.01112","volume":"99","author":"PM Ahrens","year":"2017","unstructured":"Ahrens PM, Garlick NI, Barber J, Tims EM. The clavicle trial: A multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures. J Bone Joint Surg Am. 2017;99(16):1345\u201354.","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"2854_CR4","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1007\/s00402-015-2329-0","volume":"135","author":"ML Prasarn","year":"2015","unstructured":"Prasarn ML, Meyers KN, Wilkin G, Wellman DS, Chan DB, Ahn J, et al. Dual mini-fragment plating for midshaft clavicle fractures: a clinical and Biomechanical investigation. Arch Orthop Trauma Surg. 2015;135(12):1655\u201362.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"2854_CR5","first-page":"1","volume":"89","author":"Nonoperative treatment compared with","year":"2007","unstructured":"Nonoperative treatment compared with. Plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1\u201310.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"2854_CR6","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12891-017-1444-1","volume":"18","author":"C Kihlstr\u00f6m","year":"2017","unstructured":"Kihlstr\u00f6m C, M\u00f6ller M, L\u00f6nn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish fracture register; an observational study. BMC Musculoskelet Disord. 2017;18(1):82.","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"2854_CR7","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1503\/cjs.029511","volume":"56","author":"F-JG Wijdicks","year":"2013","unstructured":"Wijdicks F-JG, Houwert RM, Millett PJ, Verleisdonk EJJM, van der Meijden OAJ. Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Can J Surg. 2013;56(1):58\u201364.","journal-title":"Can J Surg"},{"issue":"39","key":"2854_CR8","doi-asserted-by":"publisher","first-page":"e22284","DOI":"10.1097\/MD.0000000000022284","volume":"99","author":"L Li","year":"2020","unstructured":"Li L, Yang X, Xing F, Jiang J, Tang X. Plate fixation versus intramedullary nail or Knowles pin fixation for displaced midshaft clavicle fractures: A meta-analysis of randomized controlled trials. Med (Baltim). 2020;99(39):e22284.","journal-title":"Med (Baltim)"},{"issue":"3","key":"2854_CR9","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s00264-011-1422-4","volume":"36","author":"RM Houwert","year":"2012","unstructured":"Houwert RM, Wijdicks F-J, Steins Bisschop C, Verleisdonk E-J, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop. 2012;36(3):579\u201385.","journal-title":"Int Orthop"},{"key":"2854_CR10","doi-asserted-by":"crossref","unstructured":"Smith SD, Wijdicks CA, Jansson KS, Boykin RE, Martetschlaeger F, Meijer P-P, de, et al. Stability of mid-shaft clavicle fractures after plate fixation versus intramedullary repair and after hardware removal. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):448\u201355.","DOI":"10.1007\/s00167-013-2411-5"},{"key":"2854_CR11","doi-asserted-by":"crossref","unstructured":"Rompen IF, Bryan JM, van de Wall. In: Diwersi N, et al. editors. Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies. European Journal of Trauma and Emergency Surgery; 2022. Bryan Joost Marinus van de Wall, Mark van Heijl, Isabelle B\u00fcnter.","DOI":"10.1007\/s00068-021-01845-3"},{"issue":"2","key":"2854_CR12","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.jse.2023.08.008","volume":"33","author":"T Pastor","year":"2024","unstructured":"Pastor T, Zderic I, Berk T, Souleiman F, V\u00f6gelin E, Beeres FJP, et al. New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a Biomechanical comparative study. J Shoulder Elb Surg. 2024;33(2):409\u201316.","journal-title":"J Shoulder Elb Surg"},{"key":"2854_CR13","doi-asserted-by":"publisher","first-page":"105634","DOI":"10.1016\/j.clinbiomech.2022.105634","volume":"94","author":"T Pastor","year":"2022","unstructured":"Pastor T, Knobe M, van de Wall BJM, Rompen IF, Zderic I, Visscher L, et al. Low-profile dual mini-fragment plating of diaphyseal clavicle fractures. A Biomechanical comparative testing. Clin Biomech (Bristol Avon). 2022;94:105634.","journal-title":"Clin Biomech (Bristol Avon)"},{"issue":"7","key":"2854_CR14","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1016\/j.jse.2016.01.018","volume":"25","author":"RM Houwert","year":"2016","unstructured":"Houwert RM, Smeeing DPJ, Ahmed Ali U, Hietbrink F, Kruyt MC, van der Meijden OA. Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Shoulder Elb Surg. 2016;25(7):1195\u2013203.","journal-title":"J Shoulder Elb Surg"},{"key":"2854_CR15","doi-asserted-by":"crossref","unstructured":"Renfree T, Conrad B, Wright T. Biomechanical comparison of contemporary clavicle fixation devices. The Journal of Hand Surgery. 2010; 35(4):639\u201344. Available from: URL: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0363502309011137","DOI":"10.1016\/j.jhsa.2009.12.012"},{"issue":"4","key":"2854_CR16","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/j.csm.2023.05.005","volume":"42","author":"M Trivellas","year":"2023","unstructured":"Trivellas M, Wittstein J. Midshaft clavicle fractures: when is surgical management indicated and which fixation method should be used?? Clin Sports Med. 2023;42(4):633\u201347.","journal-title":"Clin Sports Med"},{"issue":"7","key":"2854_CR17","first-page":"823","volume":"101","author":"H-J Chung","year":"2015","unstructured":"Chung H-J, Hong K-J, Kim D-S. Biomechanical properties of titanium elastic nail applied to a cadaveric clavicle model. Orthop Traumatology: Surg Res. 2015;101(7):823\u20136.","journal-title":"Orthop Traumatology: Surg Res"},{"issue":"3","key":"2854_CR18","doi-asserted-by":"publisher","first-page":"230949902097220","DOI":"10.1177\/2309499020972204","volume":"28","author":"JS Park","year":"2020","unstructured":"Park JS, Ko SH, Hong TH, Ryu DJ, Kwon DG, Kim M-K, et al. Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications. J Orthop Surg (Hong Kong). 2020;28(3):2309499020972204.","journal-title":"J Orthop Surg (Hong Kong)"},{"issue":"4","key":"2854_CR19","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.injury.2018.02.017","volume":"49","author":"MH Hulsmans","year":"2018","unstructured":"Hulsmans MH, van Heijl M, Houwert RM, Burger BJ, Verleisdonk EJM, Veeger DJ, et al. Surgical fixation of midshaft clavicle fractures: A systematic review of Biomechanical studies. Injury. 2018;49(4):753\u201365.","journal-title":"Injury"},{"issue":"3","key":"2854_CR20","doi-asserted-by":"publisher","first-page":"82","DOI":"10.4103\/0973-6042.102557","volume":"6","author":"AP Kadakia","year":"2012","unstructured":"Kadakia AP, Rambani R, Qamar F, McCoy S, Koch L, Venkateswaran B. Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases. Int J Shoulder Surg. 2012;6(3):82\u20135.","journal-title":"Int J Shoulder Surg"},{"issue":"1","key":"2854_CR21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s11678-014-0284-y","volume":"10","author":"C Faymonville","year":"2015","unstructured":"Faymonville C, Libutzki PV, Hackl M, M\u00fcller LP. Elastisch-stabile intramedull\u00e4re Nagelung Bei klavikulaschaftfrakturen. Obere Extremit\u00e4t. 2015;10(1):55\u201360.","journal-title":"Obere Extremit\u00e4t"},{"issue":"4","key":"2854_CR22","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/BOT.0000000000000760","volume":"31","author":"CM Czajka","year":"2017","unstructured":"Czajka CM, Kay A, Gary JL, Prasarn ML, Choo AM, Munz JW, et al. Symptomatic implant removal following dual Mini-Fragment plating for clavicular shaft fractures. J Orthop Trauma. 2017;31(4):236\u201340.","journal-title":"J Orthop Trauma"},{"issue":"3","key":"2854_CR23","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.injury.2020.01.014","volume":"51","author":"MJ Chen","year":"2020","unstructured":"Chen MJ, DeBaun MR, Salazar BP, Lai C, Bishop JA, Gardner MJ. Safety and efficacy of using 2.4\/2.4\u00a0mm and 2.0\/2.4\u00a0mm dual mini-fragment plate combinations for fixation of displaced diaphyseal clavicle fractures. Injury. 2020;51(3):647\u201350.","journal-title":"Injury"},{"key":"2854_CR24","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jcot.2021.03.024","volume":"17","author":"DZ You","year":"2021","unstructured":"You DZ, Krzyzaniak H, Kendal JK, Martin CR, Schneider PS. Outcomes and complications after dual plate vs. single plate fixation of displaced mid-shaft clavicle fractures: A systematic review and meta-analysis. J Clin Orthop Trauma. 2021;17:261\u20136.","journal-title":"J Clin Orthop Trauma"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02854-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-025-02854-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02854-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:05:59Z","timestamp":1770721559000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-025-02854-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2854"],"URL":"https:\/\/doi.org\/10.1007\/s00068-025-02854-2","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,29]]},"assertion":[{"value":"21 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Fabian Pretz, Ivan Zderic, Bj\u00f6rn-Christian Link, Reto Babst, Yannic Lecoultre, Boyko Gueorguiev, Peter Varga, Frank J.P. Beeres, Torsten Pastor, Bryan J.M. van de Wall declare that they have no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}