Wide shoulders in a female can be an unaesthetic body feature which can be successfully reduced by clavicle osteotomies. By removing a segment of the largely horizontally oriented clavicle bone the width of the shoulders is visibly reduced. Some debate can be had about how much clavicle bone an be safely removed in this operation. But regardless of the length of bone removed, good plate and screw fixation is needed to resist motion and encourage primary bone healing.
Clavicle reduction osteotomies have been historically described as a single 2.7mm plate fixation across the osteotomy line at its superior border. This plate fixation method is borrowed from what orthopedic surgeons has used for decades in the repair of clavicle fractures. This has been largely effective in my clinical experience to date having suffered only one single clavicle fixation failure. (less than 3% occurrence) While effective it is probably a minimal fixation technique for this bone which requires an extend period of upper arm motion restriction. Given that this is a bilateral operation, such restricted arm motion can create a challenging and prolonged recovery time period. (up to six weeks)
In looking at the biomechanics stresses placed on the clavicle the major forces to resist are superior arm elevation and posterior shoulder retraction. These have been shown to cause the major 3D contributions of arm movement stresses placed on the clavicle. Protecting against these displacing forces by keeping the elbow close to one’s side during the first few weeks after surgery is the protective maneuver a patient can do.
An alternative and superior plate fixation technique for clavicle osteotomies is the application of an anterior plate as well. The superior plate primarily protects against arm elevation while the anterior plate protects against posterior shoulder retraction. This plate combination provides the optimal osteotomy line stabilization and stress displacing forces. It can also permit earlier arm mobilization (up to 45 degree) in the earlier recovery period.
There are no fixation plate designs that are made specifically for the clavicle reduction osteotomy operation. There are a lot of different types of clavicle fracture plate designs that are available which are made for mid- to lateral clavicle fracture sites. While medial clavicle fractures do occur they are rare, only require a long superior plate for repair and occur only on one side. The plating needs for an elective aesthetic operation for the clavicle require different design considerations. And until such a new clavicle plate design emerges, double plate fixation provides the most assured bone stabilization method that allows for the earliest arm motion recovery.
Dr. Barry Eppley
Indianapolis, Indiana