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In clavicle reduction osteotomies for reductive shoulder reshaping surgery, the key technical step in the procedure is holding the bone in place once it is put back together. This bone fixation is done by titanium plates and screws of which there is a wide variety of types and manufacturers. All of these plate and screw clavicle systems are made for repairing traumatic fractures of the collarbone since elective osteotomies for changing the length of the clavicle has not existed until recently.

But since clavicle fractures are typically more unstable bone segments than a clean osteotomy line due to fragmentation and non-linear patterns, the use of trauma plates for clavicle osteotomies should work just as well if not better.  But what exact plate lengths and screw widths to use for clavicle osteotomies is not an exact science and no formal guidelines exist for their use. To date I have been cautious and used a double plating technique with a longer plate placed in the superior bone surface and a smaller plate on the anterior bone surface, both using bicortical 2.7mm screw diameters.

But in an effort to seek continued technical refinements the use of a smaller single superior plate with 3.5mm bicortical screws has been used. This provides less indwelling metal material but with very strong fixation across the osteotomy sites. As the weakest link in almost any plate and screw bone fixation is not the risk of plate fracture but screw pull out, the larger diameter screws provide better bite into the two cortical bone thicknesses. Aiding the plate fixation is the importance of intimate contact between the 90 degree ends of the two bone segments. 

The plate profile is slightly increased from 2.0 to 2.2mm but the curved undersurface of the plate allows maximal contact of the plate to the bone given its curved tubular shape. Whether this will eventually lead to an increased risk of plate visibility is not yet known. (although I suspect not)  

Dr. Barry Eppley

Indianapolis, Indiana

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