Biomechanical Design Optimization of Clavicle Midshaft Fracture Plates: A Review

Clavicle (i.e., collar bone) midshaft fracture plates (CMFPs) are widely used surgically, yet complications can occur. Also, it is unknown if CMFP configurations are always optimized using biomechanical criteria. This review surveyed CMFP biomechanical optimization paper that methodically analyzed plate and screw variables.

The Medline, PubMed, and Scopus websites were probed using the terms “biomechanics” plus “clavicle” plus “midshaft” plus “fracture” plus “plate”. CMFP papers were included if they were English-language biomechanical optimization studies that methodically permutated plate and/or screw variables to assess implant performance.

The 51 eligible papers examined plate variables (e.g. geometry, number, position) or screw variables (e.g. size, number, angle) via different outcomes (e.g. fracture motion, implant stress, construct stiffness). However, no papers optimized CMFPs by simultaneously implementing four biomechanical factors: (i) allow some fracture motion for early callus generation; (ii) lower bone and implant stress to prevent failure; (iii) retain adequate bone stress under the plate to reduce bone “stress shielding”; (iv) increase the number of loading cycles to failure to extend service life. Future research, patient factors, clinical recommendations, and paper quality were described.

This review of biomechanical optimization papers can assist engineers and surgeons to design, assess, or utilize CMFPs.