Surgical Management of Bipolar Clavicle Fractures Using Dual Plating: A Case Series

Bipolar clavicle fractures, involving ipsilateral fractures of the medial and lateral clavicle, are uncommon and may be overlooked when attention is directed to the more obvious fracture component. This case series describes four patients with displaced bipolar clavicle fractures treated by fixation of both fracture sites. Three men and one woman, aged 35-65 years, sustained the injury following road traffic accidents. The medial fracture was stabilised with a locking compression plate in all patients; the lateral fracture was treated with a hook plate in three patients and an anatomical lateral clavicle locking plate in one. One patient had an associated undisplaced second-rib fracture and another had a minor head injury, both managed conservatively. Radiological union occurred at both fracture sites in all four patients within 16-20 weeks. At six months, shoulder abduction ranged from 150° to 162° and the final Disabilities of the Arm, Shoulder and Hand (DASH) score ranged from 5 to 8. One patient developed medial screw loosening after union and underwent implant removal; no infection, neurovascular injury, or nonunion occurred. The series highlights the need to assess the entire clavicle in shoulder trauma and to use computed tomography when the medial component is uncertain. In displaced, unstable bipolar fractures, fixation of both components can provide a stable construct for early rehabilitation, although larger comparative studies are required before a preferred strategy can be established.