Anatomical Reduction for Treatment of Displaced Midshaft Clavicular Fractures: Knowles Pinning Vs Reconstruction Plating

The purpose of this study was to compare Knowles pinning and fixation with cerclage wires vs reconstruction plating and fixation with extraplate wires for the treatment of displaced midshaft clavicular fractures, with anatomical reduction serving as the objective. In this retrospective study, the records of 103 consecutive patients with complete follow-up data (minimum 12 months follow-up) treated operatively for displaced midshaft clavicular fractures between 1997 and 2009 by a single surgeon were reviewed. A total of 53 patients (mean age, 35.2 +/- 14.5 years) received Knowles pinning and 50 patients (mean age, 39.9 +/- 14.8 years) received reconstruction plating. No differences were observed between the groups with respect to type of fracture, union rate (88.7% vs 94.0%, respectively; P = .439), and surgical complication rate (13.2% vs 10.0%, respectively; P = .761). Wound length was significantly shorter in the Knowles pinning group (5.3 +/- 0.9 cm vs 8.4 +/- 0.5 cm, respectively; P = .001) and implant-related complications, symptomatic hardware (P = .001), visible implant (P = .001), and palpable implant (P = .015) were significantly higher in the reconstruction plating than in the pinning group. Anatomical reduction is the ultimate objective of anatomical and functional restoration when surgical intervention is indicated, and patient compliance is the major prerequisite for surgical treatment. For treatment of displaced midshaft clavicle fractures, both Knowles pinning with cerclage wires and reconstruction plating with extraplate wires provide rigid fixation and perfect union.