{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:59:19Z","timestamp":1777636759663,"version":"3.51.4"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To determine whether a difference in plate position for fixation of acute, displaced, midshaft clavicle fractures would affect the rate of secondary intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective Comparative Study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Two academic Level 1 Regional Trauma Centers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients:<\/jats:title>\n            <jats:p>Five hundred ten patients treated surgically for an acutely displaced midshaft clavicle fracture between 2000 and 2013 were identified and reviewed retrospectively at a minimum of 24 months follow-up (F\/U). Fractures were divided into 2 cohorts, according to plate position: Anterior-Inferior (AI) or Superior (S). Exclusion criteria included age &lt;16 years, incomplete data records, and loss to F\/U. Group analysis included demographics (age, sex, body mass index), fracture characteristics (mechanism of injury, open or closed), hand dominance, ipsilateral injuries, time between injury to surgery, time to radiographic union, length of F\/U, and frequency of secondary procedures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>Patients were treated either with AI or S clavicle plating at the treating surgeon's discretion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measures:<\/jats:title>\n            <jats:p>Rate and reason for secondary intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Statistical Analysis:<\/jats:title>\n            <jats:p>Fisher exact test, <jats:italic toggle=\"yes\">t<\/jats:italic> test. and odds ratio were used for statistical analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Final analysis included 252 fractures\/251 patients. One hundred eighteen (47%) were in group AI; 134 (53%) were in group S. No differences in demographics, fracture characteristics, time to surgery, time to union, or length of F\/U existed between groups. Seven patients\/7 fractures (5.9%) in Group AI underwent a secondary surgery whereas 30 patients\/30 fractures (22.3%) in group S required a secondary surgery. An additional intervention secondary to superior plate placement was highly statistically significant (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Furthermore, because 80% of these subsequent interventions were a result of plate irritation with patient discomfort, the odds ratio for a second procedure was 5 times greater in those fractures treated with a superior plate.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>This comparative analysis indicates that AI plating of midshaft clavicle fractures seems to lessen clinical irritation and results in significantly fewer secondary interventions. Considering patient satisfaction and a reduced financial burden to the health care system, we recommend routine AI plate application when open reduction internal fixation of the clavicle is indicated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000000856","type":"journal-article","created":{"date-parts":[[2017,5,26]],"date-time":"2017-05-26T12:24:11Z","timestamp":1495801451000},"page":"468-471","source":"Crossref","is-referenced-by-count":24,"title":["Anterior-Inferior Plating Results in Fewer Secondary Interventions Compared to Superior Plating for Acute Displaced Midshaft Clavicle Fractures"],"prefix":"10.1097","volume":"31","author":[{"given":"Rafael","family":"Serrano","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of South Florida, Tampa, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amrut","family":"Borade","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center, Orthopaedic Institute, Danville, PA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassan","family":"Mir","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjan","family":"Shah","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Watson","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Infante","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Frankle","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Mighell","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Claude","family":"Sagi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Harborview Medical Center, Seattle, WA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel S.","family":"Horwitz","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center, Orthopaedic Institute, Danville, PA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy W.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of South Florida, Tampa, FL;"},{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-20230828","first-page":"127","article-title":"The incidence of fractures of the clavicle","author":"Nordqvist","year":"1994","journal-title":"Clin Orthop Relat Res."},{"key":"R3-20230828","first-page":"35","article-title":"Deficits following nonoperative treatment of displaced midshaft clavicular fractures","volume":"88-A","author":"McKee","year":"2006","journal-title":"J Bone Joint Surg Am."},{"key":"R4-20230828","first-page":"1","article-title":"Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial","volume":"89A","year":"2007","journal-title":"J Bone Joint Surg Am."},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/BOT.0b013e3181c3e505","article-title":"Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter randomized, controlled trial","volume":"24","author":"Pearson","year":"2010","journal-title":"J Orthop Trauma."},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"675","DOI":"10.2106\/JBJS.J.01364","article-title":"Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials","volume":"94","author":"McKee","year":"2012","journal-title":"J Bone Joint Surg Am."},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.2106\/JBJS.L.00307","article-title":"Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial","volume":"95","author":"Robinson","year":"2013","journal-title":"J Bone Joint Surg Am."},{"key":"R8-20230828","doi-asserted-by":"crossref","first-page":"613","DOI":"10.2106\/JBJS.N.00449","article-title":"Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial","volume":"97","author":"van der Meijden","year":"2015","journal-title":"J Bone Joint Surg Am."},{"key":"R9-20230828","doi-asserted-by":"crossref","first-page":"620","DOI":"10.2106\/JBJS.N.00497","article-title":"Single, superiorly placed reconstruction plate compared with flexible intramedullary nailing for midshaft clavicular fractures: a prospective, randomized controlled trial","volume":"97","author":"Andrade-Silva","year":"2015","journal-title":"J Bone Joint Surg Am."},{"key":"R10-20230828","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/01.bot.0000249434.57571.29","article-title":"Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle","volume":"20","author":"Collinge","year":"2006","journal-title":"J Orthop Trauma."},{"key":"R11-20230828","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1097\/00005131-200207000-00011","article-title":"Anteroinferior plating of midshaft clavicular nonunions","volume":"16","author":"Kloen","year":"2002","journal-title":"J Orthop Trauma."},{"key":"R12-20230828","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/BOT.0b013e318254883a","article-title":"Results of anterior-inferior 2.7-mm dynamic compression plate fixation of midshaft clavicular fractures","volume":"27","author":"Jones","year":"2013","journal-title":"J Orthop Trauma."},{"key":"R13-20230828","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/BOT.0b013e3181c3f6d4","article-title":"Superior versus anteroinferior plating of the clavicle revisited: a mechanical study","volume":"24","author":"Partal","year":"2010","journal-title":"J Orthop Trauma."},{"key":"R14-20230828","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/BOT.0b013e3181d8893a","article-title":"Biomechanical analysis of fixation of middle third fractures of the clavicle","volume":"25","author":"Drosdowech","year":"2011","journal-title":"J Orthop Trauma."},{"key":"R15-20230828","doi-asserted-by":"crossref","first-page":"e898","DOI":"10.3928\/01477447-20130624-20","article-title":"Superior versus anteroinferior plating of clavicle fractures","volume":"36","author":"Formaini","year":"2013","journal-title":"Orthopedics"},{"key":"R16-20230828","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00402-009-0864-2","article-title":"Treatment of midshaft clavicular delayed and non-unions with anteroinferior locking compression plating","volume":"130","author":"Stufkens","year":"2010","journal-title":"Arch Orthop Trauma Surg."},{"issue":"suppl 10","key":"R17-20230828","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium\u20142007: orthopaedic trauma association classification, database and outcomes committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma."},{"key":"R18-20230828","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1067\/mse.2002.125805","article-title":"Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study","volume":"11","author":"Iannotti","year":"2002","journal-title":"J Shoulder Elbow Surg."},{"key":"R19-20230828","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1097\/BOT.0b013e3182143e06","article-title":"Superior versus anteroinferior plating of the clavicle: a finite element study","volume":"25","author":"Favre","year":"2011","journal-title":"J Orthop Trauma."},{"key":"R20-20230828","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1302\/0301-620X.93B9.25739","article-title":"A radiological study to define safe zones for drilling during plating of clavicle fractures","volume":"93","author":"Sinha","year":"2011","journal-title":"J Bone Joint Br."},{"key":"R21-20230828","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.jse.2015.09.005","article-title":"Anteroinferior versus superior plating of clavicle fractures","volume":"25","author":"Hulsmans","year":"2016","journal-title":"J Shoulder Elbow Surg."},{"key":"R22-20230828","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.2106\/JBJS.M.00607","article-title":"Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study in ontario, Canada","volume":"96","author":"Leroux","year":"2014","journal-title":"J Bone Joint Surg Am."},{"key":"R23-20230828","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/BOT.0000000000000225","article-title":"A cost analysis of internal fixation versus nonoperative treatment in adult midshaft clavicle fractures using multiple randomized controlled trials","volume":"29","author":"Walton","year":"2015","journal-title":"J Orthop Trauma."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00005131-201709000-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T06:52:05Z","timestamp":1693205525000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00005131-201709000-00003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000000856","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2017,9]]}}}