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Meta-analysis shows anteroinferior plating improves shoulder function over superior plating for clavicle fracturesAnteroinferior plating improves shoulder function after clavicle fracture

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Key Takeaway
Meta-analysis suggests anteroinferior plating improves shoulder function and reduces minor neuro injury risk versus superior plating.

This meta-analysis compared anteroinferior plating against superior plating for mid-shaft fractures of the clavicle in an adult population. The analysis included 1,433 patients, though the setting was not reported. The primary outcome measured shoulder function using the Constant-Murley score.

secondary_outcomes included the Disabilities of the Arm, Shoulder and Hand questionnaire, neurological injury, implant removal, postoperative pain, time to union, nonunion rates, infection, and operating time. The follow-up duration was not reported.

Results indicated that anteroinferior plating yielded significantly higher Constant-Murley scores with a mean difference of -1.91 (95% CI -3.25 to -0.57; p = 0.005). Anteroinferior plating was associated with a significantly lower risk of minor neurological injury, with a risk ratio of 3.69 (95% CI 1.03 to 13.25; p = 0.050).

No significant differences were observed for the DASH score (p = 0.110), implant removal (p = 0.350), postoperative pain (p = 0.620), nonunion rate (p = 0.250), infection rate (p = 0.600), time to union (p = 0.520), or operating time (p = 0.580). The authors note that findings support the growing adoption of anteroinferior plating as a safe and effective alternative.

For people with a broken collarbone, the type of surgery used to fix it may matter. A new analysis of 1,433 adults with mid-shaft clavicle fractures compared two common surgical approaches: anteroinferior plating and superior plating.

The study found that anteroinferior plating led to significantly better shoulder function, as measured by the Constant-Murley score. Patients who had this approach also had a lower risk of minor nerve injury. However, there were no significant differences between the two methods in terms of arm and hand function, pain, implant removal, infection, or how quickly the bone healed.

This analysis combined results from several studies, which strengthens the evidence. However, the individual studies may have varied in quality and design. The findings support the idea that anteroinferior plating is a safe and effective option for fixing broken collarbones.

If you or someone you know needs surgery for a clavicle fracture, this research suggests that the choice of plating technique may influence recovery. Talk to your surgeon about which approach might be best for your specific situation.

What this means for you:
Anteroinferior plating may offer better shoulder function and fewer nerve injuries for clavicle fractures.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
AIMS: Superior plating has long been the routine surgical approach for mid-shaft fractures of the clavicle. However, concerns about the prominence of the plate and neurological risk have led to an increased interest in anteroinferior plating. Whether anteroinferior plating offers comparable or improved outcomes without compromising the stability of fixation has been investigated in several studies. The aim of this meta-analysis was to evaluate the clinical outcomes, complications, and complication-related outcomes following superior compared with anteroinferior plating of mid-shaft fractures of the clavicle. METHODS: A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar until 22 August 2025. Randomized controlled trials and observational studies comparing superior and anteroinferior plating techniques for mid-shaft clavicular fractures in adults were included. A total of 13 studies met the inclusion criteria, including 1,433 adult patients with these fractures. The outcomes which were assessed included the Constant-Murley score (shoulder function), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, neurological injury, implant removal, postoperative pain (visual analogue scale), time to union, the rates of nonunion and infection, and operating time. RESULTS: Anteroinferior plating yielded significantly higher Constant-Murley scores compared with superior plating (mean difference -1.91 (95% CI -3.25 to -0.57); p = 0.005). Anteroinferior plating was also associated with a significantly lower risk of minor neurological injury compared with superior plating, with a risk ratio of 3.69 (95% CI 1.03 to 13.25; p = 0.050). There were no significant differences in the mean DASH score (p = 0.110), implant removal (p = 0.350), postoperative pain (p = 0.620), nonunion rate (p = 0.250), infection rate (p = 0.600), time to union (p = 0.520), or operating time (p = 0.580) between the groups. CONCLUSION: Anteroinferior plating provides significantly better shoulder function with a significantly reduced risk of minor neurological injury compared with traditional superior plating. These findings support the growing adoption of anteroinferior plating as a safe and effective alternative for the surgical treatment of mid-shaft fractures of the clavicle.
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