Clinical outcome of internal fixation of middle third clavicle fractures using locking compression plate: comparison between conventional open plating and minimally invasive plate osteosynthesis

Abstract

Objective: To compare the outcomes of conventional open plating and minimally invasive plate osteosynthesis (MIPO) for treatment of displaced middle third clavicle fractures. Methods: A retrospective cohort study. From January 2016 to December 2020, a total of 42 patients with middle third clavicle fractures treated with locking compression plates in the Department of Orthopedics, Nanping First Hospital Affiliated to Fujian Medical University were analyzed retrospectively, including 27 males and 15 females with a mean age of (36.5±8.7) years (19-61 years). According to the different treatment methods, the patients were divided into 2 groups: the traditional incision group (n=20) were treated with conventional open plating and the MIPO group (n=22) were treated with the MIPO technique. The supraclavicular nerve was preserved in those patients. The two groups were compared in terms of operation time, intraoperative blood loss, incision length, fracture healing time, and the ratio and length difference with the uninjured clavicle. The shoulder joint function was evaluated with Constant score and Disability of the Arm, Shoulder and Hand score (DASH) at the last follow-up. The incidence of numbness around the incision was evaluated at 6 weeks, 12 weeks and 1 year after operation, and the complications of the two groups were compared. Results: The patients were followed-up for an average of 16.5 months (ranged from 13 to 35 months). The operating time [(68.4±12.7) min vs (55.3±10.2) min], intraoperative blood loss[(72.5±16.9) ml vs (52.8±13.5) ml], as well as incision length [(8.7±2.3) cm vs (4.5±1.2) cm] were all significantly greater in traditional incision group than those in MIPO group (all P<0.05). There was no significant difference between the two groups in the time of fracture healing, the length of contrast with the contralateral clavicle, and the constant score and DASH score of shoulder joint function at the last follow-up (all P>0.05). The incidence of numbness around the incision after operation at 6 weeks [60.0%(12/20) vs 27.3%(6/22)] and 12 weeks [45.0%(9/20) vs 13.6%(3/22)] were obviously higher in traditional incision group than those in MIPO group (both P<0.05), but there was no significant difference between the two groups at 1 year after operation [15.0%(3/20) vs 4.5%(1/22), P=0.531]. There was no significant difference in postoperative complications incidence between the two groups (P>0.05). Conclusions: It is showed that both conventional open plating and MIPO are effective and safe treatment methods for displaced middle third clavicle fractures with locking compression plates. MIPO can reduce operating time, intraoperative blood loss and the incidence of early postoperative numbness around the incision.