Surgical Treatment of Clavicle Midshaft Fractures Using a Locking Compression Plate: Conventional Open Reduction and Plating with Internal Fixation versus Minimal Invasive Plate Osteosynthesis

Jin-Young Bang; Byung Ook Park; Yong Min Seo; Dae Wook Kim; Dong-Hyun Lee; Youngbok Kim; Young Chang Kim; Ji Wan Kim

doi:10.4055/jkoa.2017.52.6.529

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Bang, Park, Seo, Kim, Lee, Kim, Kim, and Kim: Surgical Treatment of Clavicle Midshaft Fractures Using a Locking Compression Plate: Conventional Open Reduction and Plating with Internal Fixation versus Minimal Invasive Plate Osteosynthesis

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(6): 529-536.

Published online: 22 December 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.6.529

Surgical Treatment of Clavicle Midshaft Fractures Using a Locking Compression Plate: Conventional Open Reduction and Plating with Internal Fixation versus Minimal Invasive Plate Osteosynthesis

Jin-Young Bang, M.D., Byung Ook Park, M.D., Yong Min Seo, M.D., Dae Wook Kim, M.D., Dong-Hyun Lee, M.D., Youngbok Kim, M.D., Young Chang Kim, M.D., Ph.D., Ji Wan Kim, M.D., Ph.D.

Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Correspondence to: Ji Wan Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. TEL: +82-51-797-0668, FAX: +82-51-797-0669, bakpaker@hanmail.net

Received 14 March 2017 Revised 12 May 2017 Accepted 7 June 2017

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to make a comparison between minimally invasive plate osteosynthesis (MIPO) and conventional open reduction and plating (COP) to treat displaced clavicle shaft fractures.

Materials and Methods

We retrospectively reviewed patients with clavicle shaft fractures, who underwent surgery by using a locking plate between May 2011 and August 2016. The inclusion criteria were: 1) displaced ≥20 mm, 2) acute fracture of less than 2 weeks from injury, 3) skeletally mature patients, and 4) follow-up of at least 6 months. The demographic data and clinical outcomes, including operation time, fracture union rate, union time, shortening of clavicle, shoulder functional score (University of California at Los Angeles score), and complications, were evaluated. The clavicle length ratio was measured to evaluate shortening. We compared the clinical outcomes between two groups: the COP group that included 21 patients treated with COP (group 1) and the MIPO group that included 19 patients treated with MIPO (group 2).

Results

In all cases, union of fractures was successfully achieved. The mean union time was 14.9 weeks in group 1 and 14.2 weeks in group 2 (p=0.713). Both groups had good functional scores (34.0 vs. 33.7, p=0.658). Group 2 had shorter operation time and less bleeding. There were no secondary interventions or infections. The clavicle length ratio was similar between the two groups; and all patients in both groups showed no shortening (less than 3%). There were no implant failures in either group.

Conclusion

The clinical and radiologic outcomes were satisfactory in both groups. We suggest that MIPO may be a safe and effective method for displaced clavicle shaft fractures.

Keywords: clavicle, clavicle fracture, minimally invasive plate osteosynthesis, plate, outcomes

Figures and Tables

Figure 1

Surgical technique of minimal invasive plate osteosynthesis. (A) Patient positioning. Black arrow indicates padding on the interscapular space. (B) Marking of fracture configuration. (C) Plate positioning under fluoroscopic images. (D) Submuscular tunneling. (E) Use of reduction forces. (F) Reduced fragment. (G) Maintenance of clavicle length with a drill bit on each fragment. (H) Indirect reduction with a cortical screw. (I) Confirmation of alignment and fixation of 3 screws on each fragment. (J) A 2 cm-length separate skin incisions.

Figure 2

A 34-year-old male patient treated with conventional open reduction plating. (A) Preoperative x-ray. (B) Immediate postoperative x-ray. (C) Postoperative x-ray at 12 months follow-up.

Figure 3

A 35-year-old male patient treated with minimal invasive plate osteosynthesis. (A) Preoperative x-ray. (B) Immediate postoperative x-ray. (C) Postoperative x-ray at 12 months follow-up.

Figure 4

Measurement of clavicle shortening. Clavicle length ratio=a/b.

Table 1

Demographics of Participants

Values are presented as number only, mean±standard deviation, or number (%). Group 1, treated with conventional open reduction and plating; Group 2, treated with minimally invasive plate osteosynthesis; BMI, body mass index; DM, diabetes mellitus; TA, traffic accident.

Table 2

Clinical Features and Outcomes according to Surgical Method

Values are presented as mean±standard deviation or number only.

^*Statistically significant (p<0.05). Group 1, treated with conventional open reduction and plating; Group 2, treated with minimally invasive plate osteosynthesis; UCLA, University of California at Los Angeles.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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