What question did this study set out to answer?

To compare the outcomes of superior versus anteroinferior plating in treating displaced midshaft clavicle fractures.

February 28, 2026Open Access

Superior versus anteroinferior plating for displaced midshaft clavicle fractures: a systematic review and meta-analysis of union, function, and complications

JLJustin LeRowan University FTFaisal Al TaieRowan University TLTien LamAlbany Medical Center Hospital

Key Points

To compare the outcomes of superior versus anteroinferior plating in treating displaced midshaft clavicle fractures.
Systematic review and meta-analysis following PRISMA guidelines.
Included randomized trials and cohort studies focusing on adult clavicular fractures.
Outcomes assessed included DASH and Constant-Murley scores, union rates, and complications.
Twelve studies involving 980 patients were analyzed.
No significant differences in Constant-Murley scores (MD=-1.19, P=0.24) or DASH scores (MD=1.62, P=0.13).
Times-to-union and nonunion rates were comparable, with odds ratios showing no significant differences.
Complications like plate removal and infection also did not differ significantly.

Abstract

Background: Fixation of clavicular shaft fractures carries risks of nonunion, infection, and functional loss. Although superior and anteroinferior plating have widely been studied, the optimal approach remains debated. Previous literature has relied on indirect comparisons and been limited by early study cutoffs, high heterogeneity, and omission of key outcomes. This meta-analysis directly compared union, function, and complications between superior and anteroinferior plating.Methods: This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Eligible studies included randomized trials or prospective/retrospective cohort studies of adults. Outcomes of interest included the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; and complications (plate removal, infection, nonunion). Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions or Cochrane Risk of Bias 2.0 tool, and certainty of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Analyses were performed in Review Manager 5.4 (Cochrane).Results: Twelve studies (n=980) were included. Constant-Murley scores did not differ significantly (mean difference MD=−1.19; 95% CI, −3.18 to 0.81; P=0.24). Beginning at 2 years, DASH scores showed no difference (MD=1.62; 95% CI, −0.46 to 3.70; P=0.13). Times-tounion (MD=0.41; 95% CI, −0.60 to 1.43; P=0.42) and rates of nonunion (odds ratio OR=2.42; 95% CI, 0.59–9.94; P=0.22) were comparable. Plate removal (OR=1.16; 95% CI, 0.82–1.65; P=0.41) and infection (OR=0.81; 95% CI, 0.32–2.06; P=0.66) also showed no significant differences. Heterogeneity was minimal (I2=0).Conclusions: Superior and anteroinferior plating of midshaft clavicle fractures provide comparable union rates, functional outcomes, and complication rates. Selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors.Level of evidence: III.

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