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

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Abstract
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.

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