J Korean Orthop Assoc.  2017 Oct;52(5):403-410. 10.4055/jkoa.2017.52.5.403.

The Usefulness of Minimally Invasive Plate Osteosynthesis to Manage Comminuted Mid-Clavicle Fracture: A Comparison with Conventional Open Plating

• Kang TW
• Hwang HJ
• Lee DK
• Han SB
• Jeong WK

• KMID: 2393512
• DOI: http://doi.org/10.4055/jkoa.2017.52.5.403

Abstract

PURPOSE
The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with those of conventional open plating (COP) for treating comminuted mid-clavicular fractures and to evaluate the usefulness of MIPO.
MATERIALS AND METHODS
Thirty-nine patients who underwent surgical treatment for mid-clavicular comminuted fractures were analyzed retrospectively. Nineteen patients were treated with MIPO and twenty patients with COP. Radiological evaluation included time to union, fracture healing, and clavicular length difference measured as the proportional length difference with the unaffected side. Clinical assessment was performed using the simple shoulder test score, American Shoulder and Elbow Surgeons score, and quick disability of the arm, shoulder and hand score. Moreover, the mean operation and radiation times, as well as exposure were compared.
RESULTS
All clavicles achieved bone union. The mean time to union was 12.1 weeks in the MIPO group, and 14.6 weeks in the COP group (p=0.587). There was no significant difference between the two groups regarding the functional and radiological outcomes at 2-year follow-up. A significantly shorter operation time was observed in the MIPO group than in the COP group (75.8 min vs. 106.9 min, p=0.002). More radiation time and exposure were identified in the MIPO group (52.8 s vs. 37.1 s, p=0.002; 209.4 mGy vs. 43.1 mGy, p=0.005).
CONCLUSION
Both COP and MIPO were shown to be effective treatment options for mid-clavicular comminuted fractures. MIPO may be a better alternative to COP due to shorter operation time and no need for a bone graft, although the functional and radiological outcomes were not significantly different. However, all surgeons should pay close attention to minimize radiation hazard.

Keyword

clavicle; fracture; minimally invasive plate osteosynthesis

MeSH Terms

Arm
Clavicle
Elbow
Follow-Up Studies
Fracture Healing
Fractures, Comminuted
Hand
Humans
Retrospective Studies
Shoulder
Surgeons
Transplants

Figure

• 

  Figure 1 Operation steps of minimally invasive plate osteosynthesis for clavicle fracture. (A) After measuring the contralateral clavicle length, pre-bending of the plate was performed along the contour of the cadaveric bone. (B) Two small incisions (approximately 2 cm) were made at the medial and lateral sides of the fracture site. (C) Two drill-bits were inserted through the locking drill sleeves, located at the medial and lateral end of the plate, then displacement was reduced using the joystick technique. (D) After restoration of alignment and length, one cortical screw and two locking screws were inserted at each side of the fracture.

• 

  Figure 2 Serial plain radiographs of mid-claviclar fractre treated with minimally invasive plate osteosynthesis. (A) Preoperative radiograph shows that the right clavicle is shortened and displaced compared with the left clavicle. (B) Clavicle anteroposterior (AP) radiograph taken just after the operation shows a reduced and fixed dispaced fragment. (C) Clavicle AP radiograph taken 3 months after the operation shows bone union. (D) Clavicle AP radiograph taken 1 year after the operation shows restroation length and alignment of right clavicle.

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