Purpose: The aim of this nonrandomised retrospective study was to compare the results of anterior plating with superior plating in acute mid-shaft clavicular fractures.

Method: From 2000–2005, 49 fresh midshaft clavicular fractures in adults with shortening of > 20mm on the radiographs were treated with reconstruction plates. The placement of the plate on the clavicular surface was based on the preference of the surgeon operating. Patients were discharged within a day or two of the operation depending on pain control and were allowed to mobilise their shoulder within pain limits. They were followed up at six weeks and 12 weeks post operation and were allowed to return to work by 12 weeks if there was clinical and radiological signs of union. There were 22 patients in the anterior and 27 in the superior group. The mean age in the anterior was 36.3 years and 37.6 in the superior group. Majority(65%) of the fractures were sustained following RTA.77% were involved on the dominant side in both groups. The percent of patients in light and heavy manual work were similar in both groups. Follow up varied from six months to 24 months. Functional outcome was analysed by the physiotherapist with Biodex machine using Constant score and patient satisfaction questionnaire.

Results: There was no significant difference in Constant scores (Anterior=89, Superior=86), patient satisfaction with operation, return to activity and occupation in either groups. There was a total of six implant removals out of which five were in the superior group due to prominent metalware. There were two implant failures between six to 12 weeks post operation, both of which were in the superior group which were replated anteriorly. There was no significant difference in the deep/superficial infection in either groups. Return to work and satisfaction with operation were similar in both groups.

Conclusion: In our study, the incidence of hardware failure and hardware removal was significantly higher in the superior group compared to anterior group. Necessity for hardware removal becomes low as the anteriorly placed plate is less prominent. Also the risk of injuring the important neurovascular structures is less while drilling holes from anterior to posterior compared to superior to inferior direction. Hence we recommend anterior plating of the clavicle as a better method compared to superior plating of the clavicle.