Preliminary Report of Minimally Invasive Plate Osteosynthesis with Vertical Incisions for Mid-shaft Clavicular Fractures: a Surgical Technique and its Results
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Abstract
OBJECTIVE:
One of the most common surgeries for mid-shaft clavicular fracture is an open reduction and internal fixation with plate and screws. When using a conventional technique of plate fixation, a long incision is used, compromising blood supply to the bone and soft tissues. This can result in delayed or nonunion, skin complications, painful scarring, infection and paraesthesia inferior to the clavicle. This study reports on a minimally invasive plate osteosynthesis with separated vertical incisions. The aim is to evaluate radiographic and clinical outcomes in mid-shaft clavicular fractures.
MATERIALS AND METHODS:
From January 2011 to July 2013, eight cases were operated using the technique. Fracture reduction was arrived at by indirect manipulation with a postural reduction under fluoroscopic guidance. Vertical incisions were done proximally and distally. We evaluated the clinical and radiographic results immediately postoperation and at 2, 4, 8 weeks and thereafter every 4 weeks postoperative until union was achieved.
RESULTS:
AO Type 15-B2.2 was the most common: all fractures healed within a mean period of 13.8 weeks (range 11-18 weeks). All patients showed good shoulder function, with a mean disabilities of the arm, shoulder and hand (DASH) score of 6.8 (range 4-15.3) at six months. There were no complications, except bending of an implant in one patient. However this patient achieved a bone union with good function. There was no numbness around the clavicle in this series. Average operative time was 128 minutes. Fluoroscopic exposure time was 29.5 seconds.
CONCLUSION:
We propose vertical incisions as an approach for plate and screws application for this MIPO technique. This presented technique is good, not only with regards to appearance but also in avoiding any associated complications. We propose this technique as an option for minimally invasive plate osteosynthesis (MIPO) for mid-shaft clavicular fractures.
Article Details
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
2. Rowe CR. An atlas of anatomy and treatment of midcla-vicular fractures. Clin Orthop Relat Res 1968;58:29-42.
3. Canadian Orthopaedic Trauma Society. Non-operative reatment compared with plate fixation of displaced mid-shaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-10.
4. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997;79:537-9.
5. Liu PC1, Chien SH, Chen JC. Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma 2010;24:217-23.
6. McKee MD, Pedersen EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 2006;88:35-40.
7. Lee HJ1, Oh CW, Oh JK, et al. Percutaneous plating for comminuted mid-shaft fractures of the clavicle:a surgical technique to aid the reduction with nail assistance. Injury 2013;44:465-70.
8. Andermahr J, Faymonville C, Rehm KE, et al. Percutaneous plate osteosynthesis for clavicular fractures. Initial description. Unfallchirurg 2008;111:43-5.
9. Zlowodzki M, Zelle BA, Cole PA, et al. Treatment of acute mid-shaft clavicle fractures: systematic review of 2144 fractures:on behalf of the Evidence-Based Ortho-paedic Trauma Working Group. J Orthop Trauma 2005;19:5047.
10. Smekal V, Irenberger A, Attal RE, Oberladstaetter J, Krappinger D, Kralinger F. Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminution: results in 60 patients. Injury 2011;42:3249.
11. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced mid- shaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-10.
12. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (dis-abilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996;29:602-8.
13. Poigenfürst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury 1992;23:237-41.
14. Duncan SF, Sperling JW, Steinmann S. Infection after clavicle fractures. Clin Orthop Relat Res 2005;439:74-8.
15. Shen JW, Tong PJ, Qu HB. A three-dimensional recon-struction plate for displaced mid-shaft fractures of the clavicle. J Bone Joint Surg Br 2008;90:1495-8.
16. Phiphobmongkol V. Clavicle. Minimally invasive plate osteosynthesis (MIPO): concepts and cases presented by AO East Asia 2007:327-57.
17. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior-inferior plating of clavicular mid-shaft fractures. Arch Orthop Trauma Surg 2012;132:239-44.