{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:36:00Z","timestamp":1787754960524,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dual-plate constructs have become an increasingly common fixation technique for midshaft clavicle fractures and typically involve the use of mini-fragment plates. The goal of this technique is to reduce plate prominence and implant irritation. However, limited biomechanical data exist for these lower-profile constructs. The study aim was to compare dual mini-fragment orthogonal plating with small-fragment clavicle plates for biomechanical noninferiority and to determine if an optimal plate configuration could be identified using a cadaveric model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-four cadaveric clavicles were randomized to 1 of 6 groups, stratified by computed tomography-based bone mineral content (BMC): precontoured superior or anterior fixation using a single 3.5-mm Locking Compression Plate (LCP), and 4 different dual-plating constructs utilizing 2.4-mm and 2.7-mm Adaptation plates or LCPs. An inferior butterfly fracture was created. Axial, torsional, and bending (anterior and superior surface loading) stiffnesses were determined through nondestructive cyclic testing, followed by a load-to-failure test in 3-point superior surface bending.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>For axial stiffness, the 2 dual-plate constructs with a superior 2.4-mm and anterior 2.7-mm plate (either Adaptation or LCP) were significantly stiffer than the other 4 constructs (p = 0.021 and p = 0.034). For both superior and anterior bending, the superior 2.4-mm and anterior 2.7-mm plate constructs were significantly stiffer when compared with the 3.5-mm superior plate (p = 0.043). No significant differences were found in torsional stiffness or load to failure between the different constructs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Dual plating using mini-fragment plates is biomechanically superior for the fixation of midshaft clavicle fractures when compared with a single, superior, 3.5-mm plate and has biomechanical properties similar to those of a 3.5-mm plate placed anteriorly. With the exception of axial stiffness, no significant differences were found when different dual-plating constructs were compared with each other.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This study validates the use of dual plating for midshaft clavicle fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.21.00123","type":"journal-article","created":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T17:01:05Z","timestamp":1652202065000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation"],"prefix":"10.2106","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0417-8052","authenticated-orcid":false,"given":"Joep","family":"Kitzen","sequence":"first","affiliation":[{"name":"Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada"},{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Orthopaedic Surgery, Maasstad Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2014-4437","authenticated-orcid":false,"given":"Kent","family":"Paulson","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Korley","sequence":"additional","affiliation":[{"name":"Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada"},{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Duffy","sequence":"additional","affiliation":[{"name":"Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada"},{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Ryan","family":"Martin","sequence":"additional","affiliation":[{"name":"Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada"},{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prism S.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada"},{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1]]},"reference":[{"issue":"1","key":"R1-20240801","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2106\/JBJS.F.00020","article-title":"Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial","volume":"89","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"R2-20240801","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/j.jcot.2019.01.019","article-title":"Incidence and mechanism of injury of clavicle fractures in the NEISS database: athletic and non athletic injuries","volume":"10","author":"DeFroda","year":"2019","journal-title":"J Clin Orthop Trauma"},{"issue":"1","key":"R3-20240801","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12891-017-1444-1","article-title":"Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study","volume":"18","author":"Kihlstr\u00f6m","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"issue":"16","key":"R4-20240801","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.2106\/JBJS.16.01112","article-title":"Clavicle Trial Collaborative Group. The Clavicle Trial: a multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures","volume":"99","author":"Ahrens","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"R5-20240801","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1097\/BOT.0000000000001602","article-title":"Operative versus nonoperative outcomes of middle-third clavicle fractures: a systematic review and meta-analysis","volume":"34","author":"Amer","year":"2020","journal-title":"J Orthop Trauma"},{"issue":"8","key":"R6-20240801","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1016\/j.injury.2020.11.066","article-title":"Midshaft clavicle fracture - nonoperative versus operative care","volume":"52","author":"Smith","year":"2021","journal-title":"Injury"},{"key":"R7-20240801","first-page":"9","article-title":"Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?","author":"Schneider","year":"2019","journal-title":"BMJ Open"},{"key":"R8-20240801","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jcot.2021.03.024","article-title":"Outcomes and complications after dual plate vs. single plate fixation of displaced mid-shaft clavicle fractures: a systematic review and meta-analysis","volume":"17","author":"You","year":"2021","journal-title":"J Clin Orthop Trauma"},{"issue":"22","key":"R9-20240801","doi-asserted-by":"crossref","first-page":"e468","DOI":"10.5435\/JAAOS-D-17-00442","article-title":"Management of midshaft clavicle fractures in adults","volume":"26","author":"Wiesel","year":"2018","journal-title":"J Am Acad Orthop Surg"},{"key":"R10-20240801","first-page":"5","article-title":"Dual versus single-plate fixation of midshaft clavicular fractures: a retrospective comparative study","author":"Allis","year":"2020","journal-title":"JB JS Open 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following dual mini-fragment plating for clavicular shaft fractures","volume":"31","author":"Czajka","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"10","key":"R17-20240801","doi-asserted-by":"crossref","first-page":"e346","DOI":"10.1097\/BOT.0000000000000633","article-title":"Extraperiosteal dual plate fixation of acute mid-shaft clavicle fractures: a technical trick","volume":"30","author":"Shannon","year":"2016","journal-title":"J Orthop Trauma"},{"issue":"9","key":"R18-20240801","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/BOT.0000000000000936","article-title":"Midshaft fractures of the clavicle: a meta-analysis comparing surgical fixation using anteroinferior plating versus superior plating","volume":"31","author":"Nourian","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"1","key":"R19-20240801","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s13018-020-01771-x","article-title":"Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study","volume":"15","author":"Boyce","year":"2020","journal-title":"J Orthop Surg Res."},{"issue":"1","key":"R20-20240801","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s13018-020-01666-x","article-title":"Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures","volume":"15","author":"Zhang","year":"2020","journal-title":"J Orthop Surg Res."},{"issue":"11","key":"R21-20240801","doi-asserted-by":"crossref","first-page":"2678","DOI":"10.1177\/0363546519865251","article-title":"Low-profile dual small plate fixation is biomechanically similar to larger superior or anteroinferior single plate fixation of midshaft clavicle fractures","volume":"47","author":"Ziegler","year":"2019","journal-title":"Am J Sports Med"},{"issue":"4","key":"R22-20240801","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.injury.2018.02.017","article-title":"Surgical fixation of midshaft clavicle fractures: a systematic review of biomechanical studies","volume":"49","author":"Hulsmans","year":"2018","journal-title":"Injury"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.21.00123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:35:33Z","timestamp":1787751333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.21.00123"}},"subtitle":["Single Plating Compared with Dual Mini-Fragment Plating"],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.21.00123","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}