LAUSR

colleagues with great interest (Li Z, Liu H, Chen D, et al. A new technique for medical-end comminuted clavicle fractures. Injury. 2019). They made an effort to show us a new technique for medialend comminuted clavicle fractures. And we appreciate their work from bottom of our heart. However, we have to point out some defects of the study, mainly in the following three aspects. First of all, the evaluation of postoperative function is not appropriate. The authors used the DASH score [1]. However, this score is mainly used for the functional evaluation of the upper limbs which unable to accurately reflect the impact of the surgery on shoulder joint activity. We think the Constant Murley score may be more appropriate [2]. Secondly, the study lacks the description of the impact on neck activity. The author fixed the plate between the two clavicle ends. This will make the plate ride across the two sternoclavicular joints. There are many ligaments and muscles at the sternoclavicular joint, especially the sternocleidomastoid muscle. When the neck turns to one side, the contralateral sternocleidomastoid muscle will contract and protrude on the skin surface [3]. If the author fixes the plate across the sternoclavicular joint, it will inevitably compress the sternocleidomastoid muscle, causing pain and affecting activity. Thirdly, the inner part of the clavicle and the sternoclavicular joint are located under the skin and can be distinguished by the naked eye. If a steel plate is placed here, it is easy to protrude on the skin surface. At the same time, there are incisions on both sides of the neck, which makes it difficult to cover up with clothes. This has a big impact on the appearance, especially for women. Is there a more minimally invasive method to improve the aesthetics after surgery? This is a question worthy of further discussion by the author.