Immediate weight bearing after dual orthogonal plate fixation of clavicle fractures: a propensity-matched retrospective cohort study

Purpose To evaluate whether immediate weight bearing as tolerated (WBAT) following open reduction and internal fixation of clavicle fractures with a dual mini-fragmentation plate construct increases complications, implant failure, or worsens functional and patient-reported outcomes compared to a restricted weight-bearing protocol. Methods Adult patients (≥ 18 years) who underwent open reduction and internal fixation of a clavicle fracture were retrospectively identified and stratified into restricted weight-bearing or weight bearing as tolerated (WBAT) cohorts. Cohorts were matched for demographic and injury characteristics. All WBAT fractures were treated with dual orthogonal mini-fragmentation plate fixation, whereas restricted weight-bearing fractures were treated with either single- or dual-plate fixation. Outcomes included complications (infection, wound dehiscence, hardware prominence, implant failure, and loss of reduction) and PROMIS Physical Function and Pain Interference scores. Results Among 378 initial patients, 93 were included after propensity score matching: 62 in the restricted weight-bearing group and 31 in the WBAT group. Complication rates were similarly infrequent between groups (all p ≥ 0.326), with no fixation failures or deep surgical site infections occurring in the WBAT group. Conclusions Early weight bearing as tolerated may be safe following dual mini-fragmentation plate fixation of clavicle fractures, with comparable complication rates, union rates, and patient-reported outcomes to restricted weight-bearing protocols. These findings support the use of early mobilization in patients with rigid internal fixation constructs and may facilitate improved functional recovery and earlier return to activity.