Journal of orthopaedic trauma
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Fixation plate positioning remains controversial in clavicle fracture reconstruction. Biomechanical studies favor a superior plate placement and clinical series report very low mechanical complications for anteroinferior plate placement. To clarify this apparent discrepancy, a biomechanical finite element analysis of the deformation mode, stress patterns, and peak stresses involved with superior and anteroinferior clavicle plate fixation was performed. ⋯ Anterorinferior plating is generally preferable, because it induces deformation modes similar to the intact clavicle and is less likely to fail during normal physiological loading (cantilever bending). Superior placement of the reconstruction plate may be recommended for a patient with a high risk of shoulder impacts (axial compression). Design improvements in the bridging area of the plate and special attention to obtain a good fixation around the fracture could reduce plate failures and provide a stiffer construct.