Ultrasound-Assisted Minimally Invasive Clavicle Plate Removal

We present the feasibility of point-of-care ultrasound (POCUS) to aid minimally invasive surgery (MIS) for clavicular plate removal. We present a case of a 29-year-old male who sustained a displaced midshaft clavicle fracture after a bike accident. On day four, post-injury, he underwent an open reduction and internal fixation with an anatomic 3.5mm locking plate, complicated by numbness of the anterior chest extending to the medial arm. Four years post-operatively, he presented for hardware irritation, which was palpable on physical exam. After unsuccessful conservative treatments, the patient elected to undergo hardware removal utilizing POCUS as the mode for a minimally invasive approach. The MIS approach, known for reducing wound complications and nerve damage, is traditionally confirmed using a C-arm image intensifier. POCUS, being a portable and non-ionizing imaging modality, serves as an alternative to traditional methods. POCUS allows for a more precise surgical incision that is smaller than the traditional open approach, with the additional advantage of visualization of neurovascular structures compared to a C-arm. Post-operatively, the patient's course was uncomplicated with no surgical site numbness and participation in previous activities at six weeks. Although additional training is required to become an expert in acquiring ultrasound skills, most hardware can be easily located through ultrasound.