Operative management of clavicular fractures includes
external fixation, intramedullary fixation, and osteosynthesis with a plate and screws. External fixation has been effective in open fractures and nonunions.16 Intramedul- lary fixation has been described as the simplest of the 3 procedures, limiting the exposure involved. However, intramedullary fixation should not be used if a plate would better maintain clavicular length.17 Plate osteosynthesis has the benefit of offering much more rigid fixation with more rotational control of the fracture.17 Shen et al18 reported a union rate of 97% in 232 athletes who underwent plate osteosynthesis, with only 1 deep infection and 4 superficial infections. No deformities or deficits in strength or range of motion were noted, and the satisfaction rate was 94%.18 In reviewing nonrandomized, noncomparative data of 635 plated fractures versus nonoperative treatment, the plated fractures had a nonunion rate of 2.5% and nonoperative treatment had a nonunion rate of 5.9%.19 With respect to