Minimally invasive plate osteosynthesis for clavicle fractures.

Abstract

Treatment of comminuted clavicle shaft fractures with minimally invasive plate osteosynthesis (MIPO). Multifragmentary (≥ 2 intermediate fragments) clavicle shaft fractures with no need for anatomical reduction (AO15.2B and15.2C). Even simple fractures (AO15.2A) with significant soft tissue injuries Tscherne gradeI-III are suitable. Medial or lateral clavicle fractures as well as simple fracture pattern where anatomical reduction is indispensable. Short incision over the medial and lateral end of the main fracture fragments. Either medial or lateral epiperosteal plate insertion. Under image intensifier guidance, the plate is centered either superior or anteroinferior on the clavicle and fixed with acompression wire temporarily (alternatively by acortical screw) in one of the most lateral holes. Fracture reduction (axis, length, and rotation) over the plate and preliminary fixation medially. After correct reduction has been achieved, further cortical screws and/or locking head screws can be inserted (lag before locking screws). Relative stability is achieved by applying abridging technique. No immobilization is needed. Patients are encouraged to perform functional rehabilitation with active and passive physical therapy. Loading is increased according to radiological signs of bony consolidation. In aretrospective evaluation from 2001-2021, 1128 clavicle osteosyntheses were performed, of which 908 (80.5%) were treated with plate osteosynthesis and 220 (19.5%) with titanium elastic nail (TEN). Of the 908 plate osteosyntheses, 43 (4.7%) were performed with the MIPO approach. Finally, 42patients (35men and 7women; mean age of 44 ± 15years) with 43clavicle shaft fractures were analyzed. The operation was accomplished in 63 ± 28 min, and average fluoroscopy time was 45 ± 42 s. Acollective of 27patients could be evaluated after amedian follow-up of 14months (range 1-51months). In all, 26fractures healed in atimely manner. In1patient apseudarthrosis occurred which was treated with re-osteosynthesis and cancellous bone grafting in an open technique. Another patient revealed awound complication with need of operative wound revision 6weeks after the index surgery. Further postoperative course was uneventful in both patients. All were pain-free and able to return to work. After an average of 17 ± 8months, 18hardware removals (66.7%) were performed.