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Shoulder width reduction is successfully done by shortening of the clavicle bones. In so doing it is necessary to rigidly fix the clavicles back together so they can proceed to uncomplicated healing. As a weight bearing bone that supports the shoulder and keeps it from collapsing towards the sternum it is exposed to significant displacing forces.

Between the pull of the pectoralis major muscle and the weight of the arm the displacing forces work towards an inferomedial and anterior type of movement that must be resisted. This direction of displacement is seen immediately after the osteotomies and bone removal. While clavicle fractures require longer and thicker plates for stabilization, elective clavicle osteotomies are inherently more stable when put together as it is a clean osteotomy line at the inner third of the bone. As a result lesser amounts of metal fixation hardware is needed.

In traditional plate fixation of clavicle reduction osteotomies, a single 6 hole 2.7mm plate is applied with bicortical screw placements. This has been adequate for all patients I have treated so far…with the exception of one. More recently I had a patient several weeks out from surgery that developed a complete displacement of the medial side of the plate and screws from the bone. As expected the lateral clavicle segment was pulled down into the upper pectorals major muscle. This was successfully repaired by a return trip to surgery where doubt plate fixation was applied.

While this fixation failure has occurred only one time, that experience as enough to convince me that double plate fixation should be routinely done. Given the setback in recovery time and the inconveniences of travel, a little extra cost up front for extra fixation hardware will make everyone rest easier that this shoulder reduction surgery complication is unlikely to happen again.

Dr. Barry Eppley

Indianapolis, Indiana

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