Clavicular fracture is a common type of fracture, accounting for approximately 2% to 5% of all fractures in the human body. Surgery is indicated for patients with significant displacement, instability, associated complications, or high functional demands, aiming to reduce the risk of nonunion and restore shoulder joint function. For fractures with obvious displacement or instability, doctors usually adopt plate internal fixation surgery to promote fracture healing. However, a small number of patients (about 1% to 3%) may experience plate breakage after surgery, which not only hinders rehabilitation but may also require a second operation (as shown in the figure below).
This article will elaborate on the causes and treatment methods of plate breakage, and provide scientific response strategies.
The Reason for Plate Breakage
1. Biomechanical Factors
The clavicle is S-shaped, and the middle third is the most fracture-prone site as well as the area bearing the greatest mechanical stress. Plates in this region are subjected to high bending and torsional stress; if fracture healing is delayed, the plate may break due to long-term fatigue.
Stress concentration: Insufficient plate length (e.g., covering only 2-3 screw holes at the fracture end) may lead to breakage at both ends of the plate or screw loosening due to stress concentration.
In addition, excessive screw fixation or steel wire ligation in comminuted fracture areas can also cause excessive stress concentration and subsequent plate breakage (as shown in the figure below).
Biomechanical experiments have revealed that insufficient plate span and inadequate screw fixation are the main mechanical factors leading to plate breakage.
2. Surgical Technical Issues
Clinically, the healing rate of conservative treatment is higher than that of surgical treatment, yet conservative treatment is mainly associated with the risk of malunion. For surgical treatment, the selection of surgical approach directly affects plate stability, which is why the incidence of surgical fracture nonunion is slightly higher than that of conservative treatment. Once surgery is opted for, the surgical method is of critical importance.
Improper plate selection:
When non-locking plates (conventional plates) are used, screws are prone to loosening, which may result in plate breakage. Such plates are now rarely used and are mostly seen in previous failed cases.
Insufficient plate thickness (e.g., 2.7 mm plates used in muscular or obese patients) may fail to provide adequate support.
Inadequate screw fixation: Insufficient number of screws (at least 6 screws are generally recommended), and all 6 screws should be placed with bicortical fixation—only such holding power can effectively resist torsional force and the gravity of the upper extremity. For special cases, such as patients with poor compliance or severe osteoporosis, bicortical fixation (screws penetrating both the anterior and posterior cortical bone of the clavicle to enhance stability) is sometimes required.
3. Patient-related Factors
The primary cause of eventual plate breakage is unhealed fracture ends or delayed bone union (nonunion). If fracture nonunion occurs, the plate has to bear more stress in place of the bone, which will eventually lead to fatigue fracture of the plate over time. Among the factors influencing nonunion, patient-related factors are particularly important, including smoking (nicotine inhibits bone healing), diabetes mellitus, malnutrition (vitamin D or calcium deficiency) and osteoporosis (poor bone quality leading to easy screw loosening). In certain cases, wound infection can also cause nonunion: postoperative infection may result in bone resorption, causing the plate to lose support and eventually break.
Treatment Methods for Plate Breakage
1. Revision Surgery (First-line Treatment)
Indications: Unhealed fracture combined with plate breakage and impaired function.Surgical goals: Restore clavicular length, achieve stable fixation and promote biological fracture healing.
2. Alternative Treatments
Intramedullary nail fixation: Suitable for patients with poor bone quality, but with weak anti-rotational capacity.
Extracorporeal shock wave therapy (ESWT): Applicable for mild nonunion, which can stimulate bone healing.
Low-intensity pulsed ultrasound (LIPUS): Promotes fracture healing, yet with a relatively slow therapeutic effect.
Conclusion
Plate breakage is a potential complication after clavicular fracture surgery, but its risk can be significantly reduced through optimized surgical techniques, strict postoperative management and rational rehabilitation. If plate breakage occurs, revision surgery combined with bone grafting is currently the most effective treatment method. Therefore, it is recommended that patients strictly follow medical advice and avoid early exercise after surgery.
Post time: Jan-21-2026