Minimally invasive plating of midshaft clavicle fractures with distal clavicle anatomic locking plate

Abstract

Background: Minimally invasive plating has been widely applied to treat long bone shaft fractures. But it was rarely used in clavicle fractures because of the technical difficulties of closed reduction and fixation. We report our improved techniques of minimally invasive treatment for midshaft clavicle fractures using distal clavicle anatomic locking plate and compare its result with that of open reduction and internal fixation.Materials and methods: A retrospective comparative study was performed in our institution from Jan 2019 to May 2020. Patients with acute midshaft clavicle fractures that were treated with minimally invasive technique or open reduction and internal fixation using distal clavicle anatomic locking plate were included. According to the included and excluded criteria, a total of 58 patients were included and divided into two groups based on the operation technique. We compared the two groups in surgical duration, fracture reduction, time for union, Constant-Murley score, cosmetic result and other complications.Results: There was no significant difference in quality of reduction between the two groups. The mean surgical duration in minimally invasive group was longer than that in open group (59.5±8.9 min vs. 52.2±7.2 min, P< 0.05). The mean incision length in minimally invasive group was shorter than that in open group (2.1±0.5 cm vs. 11.6±2.0 cm, P< 0.05). In minimally invasive group the mean union time was 3.3±1.1months, no patient complained of paresthesia on subclavicular region, and all patients were satisfied with the cosmesis of the wounds and showed excellent shoulder joint function with a mean Constant-Murley score of 93.8±3.8 at sixth month after the operation. In open reduction group the mean union time was 4.3±0.8months, 8 patients complained of paresthesia on subclavicular region, and only 5 patients were satisfied with the cosmesis of the wounds with a mean Constant-Murley score of 90.6±4.0 at sixth month after the operation. There was a significant difference in statistic by comparing union time, cosmetic result, Constant-Murley score and other complications (P＜0.05).Conclusion: Minimally invasive surgery using distal clavicle anatomic locking plate seems to be a good option for the treatment of midshaft clavicle fractures with satisfactory cosmetic result and excellent return to function.