Minimally invasive plate osteosynthesis of clavicular midshaft fractures under insertion guide

The less invasive stabilization systems for the distal femur and proximal lateral tibia have been developed to simplify the surgical technique of minimally invasive plate osteosynthesis (MIPO). MIPO, however, has simply been introduced into clavicular midshaft fixation without the aid of insertion guide though the procedure for midshaft clavicular fractures was found to produce satisfactory clinical and radiologic outcomes without serious complications. The purpose of this study was to determine the outcome of MIPO of clavicular midshaft fractures using an insertion guide.

A total of 15 patients with clavicular midshaft fractures treated by MIPO using insertion guide between September 2016 and September 2018 were included. We assessed bony union, shoulder function by the Constant score, and complications at a mean follow-up of 15.4 months (ranged from 12 to 24 months).

The mean surgical time 55.9±9.4 min (ranged from 50 to 70 min) and the fluoroscopic time was 146.5±29.0 s (ranged from 110 to 190 s). In all patients, the bony union was achieved at 8.8±1.0 weeks (ranged from 8 to 10 weeks) with no delayed unions or nonunions. The average Constant score was 99.1±1.2 (ranged from 96 to 100) at follow-up. Postoperative complications including infections, screw pull-out, hardware prominence, and neurovascular injury were not observed, however, one patient complained of mild plate discomfort.

MIPO using insertion guide is believed to be an acceptable and effective choice in the operative treatment of clavicular midshaft fractures.