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Introduction <p>Hook plates remain controversial in the management of lateral clavicle fractures despite their biomechanical advantages. Concerns include implant-related complications, subacromial irritation, and the need for routine implant removal. The aim of this study was to compare operative efficiency and surgical burden of hook plate fixation with locking plate fixation in lateral clavicle fractures.</p> Methods <p>A retrospective cohort analysis was conducted at a single tertiary trauma center between January 1, 2016, and December 31, 2024. Surgically treated lateral clavicle fractures were identified. Propensity score matching was performed based on age, sex, and AO fracture classification to reduce confounding, and matched pairs were compared between hook plate fixation (Group HP) and locking plate fixation (Group LCP). Outcome measures included operative time, complications, implant removal, radiographic callus formation, and refracture rates.</p> Results <p>A total of 101 lateral clavicle fractures were identified. After propensity score matching, 44 matched pairs (Group HP vs. Group LCP) were analyzed, with comparable baseline characteristics between groups. Operative time was significantly shorter in Group HP (77.8 ± 28.4 vs. 93.5 ± 30.2 min, p = 0.018). Complication rates were higher in Group HP but did not reach statistical significance (18.2% vs. 4.5%, p = 0.093). Implant removal was performed more frequently in Group HP (100% vs. 25%, p &lt; 0.001), although removal procedures were shorter (37.7 ± 21.5 vs. 65.7 ± 40.3 min, p = 0.003). Refracture rates after implant removal did not differ between groups, and no significant difference in radiographic callus formation was observed.</p> Conclusion <p>In this propensity score–matched cohort, hook plate fixation was associated with shorter primary operative time but required routine implant removal, resulting in increased cumulative operative exposure. No significant differences in complications or radiographic callus formation were observed. Hook plates may be a useful option in selected fractures, but the need for implant removal must be considered. Further studies including functional outcomes are needed.</p> Level of evidence <p>Level III, Retrospective comparative study.</p>

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Hook plate versus locking plate fixation in lateral clavicle fractures: operative efficiency and cumulative surgical burden in a propensity score–matched cohort study

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Désirée Schibler,
  • Michelle Antonia Hinkelmann,
  • Flurina Frei,
  • Hans-Christoph Pape,
  • Florin Allemann,
  • Christiane Barthel

摘要

Introduction

Hook plates remain controversial in the management of lateral clavicle fractures despite their biomechanical advantages. Concerns include implant-related complications, subacromial irritation, and the need for routine implant removal. The aim of this study was to compare operative efficiency and surgical burden of hook plate fixation with locking plate fixation in lateral clavicle fractures.

Methods

A retrospective cohort analysis was conducted at a single tertiary trauma center between January 1, 2016, and December 31, 2024. Surgically treated lateral clavicle fractures were identified. Propensity score matching was performed based on age, sex, and AO fracture classification to reduce confounding, and matched pairs were compared between hook plate fixation (Group HP) and locking plate fixation (Group LCP). Outcome measures included operative time, complications, implant removal, radiographic callus formation, and refracture rates.

Results

A total of 101 lateral clavicle fractures were identified. After propensity score matching, 44 matched pairs (Group HP vs. Group LCP) were analyzed, with comparable baseline characteristics between groups. Operative time was significantly shorter in Group HP (77.8 ± 28.4 vs. 93.5 ± 30.2 min, p = 0.018). Complication rates were higher in Group HP but did not reach statistical significance (18.2% vs. 4.5%, p = 0.093). Implant removal was performed more frequently in Group HP (100% vs. 25%, p < 0.001), although removal procedures were shorter (37.7 ± 21.5 vs. 65.7 ± 40.3 min, p = 0.003). Refracture rates after implant removal did not differ between groups, and no significant difference in radiographic callus formation was observed.

Conclusion

In this propensity score–matched cohort, hook plate fixation was associated with shorter primary operative time but required routine implant removal, resulting in increased cumulative operative exposure. No significant differences in complications or radiographic callus formation were observed. Hook plates may be a useful option in selected fractures, but the need for implant removal must be considered. Further studies including functional outcomes are needed.

Level of evidence

Level III, Retrospective comparative study.