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Authors of section


Jonas Andermahr, Michael McKee, Diane Nam

Executive Editor

Joseph Schatzker

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ORIF - Compression plate

1. Introduction

Goal of treatment

The goal of treatment for a simple two-part fracture of the shaft of the clavicle requires anatomical restoration of length, alignment and rotation.

In transverse and short oblique fractures of the diaphysis, placement of a lag screw is not always possible. However, axial compression can be achieved using a compression plate.

Note: This is the most common pattern. The deforming force on the medial end is the pull of the muscles and the deforming force on the lateral side is the weight of the upper extremity.

Beware of the major neurovascular bundle (subclavian artery, vein, and brachial plexus) running directly beneath the midshaft of the clavicle.

orif compression plate

Other types of deformities may occur if the coracoclavicular ligaments are disrupted (eg, superior displacement of the lateral fragment).

Plate alternatives

We will here show the procedure with a precontoured clavicular plate which has both a bend and a twist built into it.

orif compression plate

However, if a precontoured clavicular plate is not available, there are other options.

A straight plate may be used if it fits the clavicle (conventional or angle stable). If it does not, then it needs to be contoured.
This is best achieved with a slight twist at the midportion of the plate. This results in the lateral plate being applied superiorly and the medial portion anteriosuperiorly. A reconstruction plate which is easier contour may be used in smaller patients where the forces working on the plate are not as great.

Biomechanically, anterosuperior or anterior plates result in mechanically stronger fixation. The exact placement of the plate will depend on the fracture pattern and the position of the fracture.

orif compression plate

2. Patient preparation and approach

Patient preparation

This procedure is normally performed with the patient either in a beach chair or a supine position.


For this procedure an anterior approach is normally used.

orif compression plate

3. Reduction

Using the fracture interdigitations as a gauge for the reduction, obtain control over the proximal and distal fragments using reduction clamps. Gentle traction and a derotation force, typically to the lateral fragment will assist to anatomically reduce the fracture.

orif compression plate

4. Fixation

The plate is applied to one of the main fragments with a single bicortical position screw. A reduction clamp is placed on the opposite fragment.

orif compression plate

A second screw is inserted eccentrically in the opposite fragment.

orif compression plate

To increase axial compression, a second screw can be placed eccentrically.
When the second screw is tightened, the first screw needs to be loosened to allow further compression.

orif compression plate

All other screws are inserted centrically and do not serve to increase compression.

diaphyseal simple transverse

5. Aftercare

The aftercare can be divided into 4 phases:

  1. Inflammatory phase (week 1–3)
  2. Early repair phase (week 4–6)
  3. Late repair and early tissue remodeling phase (week 7–12)
  4. Remodeling and reintegration phase (week 13 onwards)

Full details on each phase can be found here.