Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures.

Abstract

This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. The average time to union of all fractures was 12.88weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.