Meta-analysis shows anteroinferior plating improves shoulder function over superior plating for clavicle fractures

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.