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Shoulder width reduction is effectively done by shortening the length of the clavicle. As the only horizontally oriented bone in the body its length largely establishes the distance between the sternum and the shoulder. By removing  2 to 3cm segment of the inner third of the clavicle the shoulder moves inward as the bone is put back together. 

Plate and screw fixation is used to put the clavicular segments back together. But unlike clavicle fracture repair, the incisional exposure is much more limited given that it is an elective aesthetic procedure and the osteotomy line is very narrow. As a result traditional plates used for clavicle fracture repair are longer than is needed and the degree of fixation they supply may be more than is needed. There really is no true plate developed specifically for clavicle reduction osteotomies.

To date I have used straight 2.7mm mandible fracture/reconstruction plates that can be cut to length for a 7 hole plate on the superior surface with an additional 5 hole anterior plate. While these plates have been very effective they have a flat surface with a thick profile.

A more appealing plate for clavicle osteotomies would have a curved shape and a lower profile. Since the clavicle is a tubular bone in shape a curved plate seems the most appropriate. With a curved plate broader surface coverage can be achieved which would allow for a bit of a lower profile to be acceptable.

These type of curved plates are used in podiatric surgery where the metatarsal bones have a tubular shape. Weight bearing in the foot is associated with different functional loading than that of the clavicles and can also be better splinted than that of the shoulders, particularly when both clavicles have been reduced. But it remains an appealing plate option in which clinical experience will determine if it has comparative effectiveness.    

Dr. Barry Eppley

Indianapolis, Indiana

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