Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction

H Jiang, W Qu
Orthopaedics & Traumatology, Surgery & Research: OTSR 2012, 98 (6): 666-71

HYPOTHESIS: The goal of the present study was to compare minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and conventional open reduction with LCP for the treatment of clavicle midshaft fractures in adults in a randomized, controlled, clinical trial with a minimum of 1-year follow-up.

MATERIALS AND METHODS: Between June 2006 and May 2008, 64 cases of open reduction and internal plate fixation were performed for clavicle midshaft fractures. The operative indications were complete displacement, severe comminution and marked shortening of the clavicle (>2cm). MIPPO and conventional open reduction surgery procedures with LCP were used in 32 and 32 cases, respectively.

RESULTS: The mean time to union was 13 weeks in the open reduction group compared to 12 weeks in MIPPO group (P>0.05). The MIPPO group had no significantly superior Constant shoulder scores or DASH scores at all time-points (P>0.05). However, the complications in the open reduction group were dysesthesia in the area of the incision and directly below in 10 cases, hypertrophic scarring in five cases, painful shoulder in two cases and a limitation of shoulder motion in one case (P>0.05). The complications in the MIPPO group were dysesthesia in two cases, no hypertrophic scarring, no painful shoulder, no limitation of shoulder motion were noted (P<0.05). Patients in this operative group were more satisfied with cosmetic appearance and overall outcome than those in the conventional open reduction group.

CONCLUSIONS: Operative treatment with a LCP for clavicle shaft fractures can be used to obtain stable fixation. Particularly, MIPPO of displaced midshaft clavicular fractures resulted in a lower rate of dysesthesia, hypertrophic scarring, and a better cosmetic than conventional open reduction, although the functional outcomes (Constant and DASH) were no different between the two groups. Overall satisfaction was higher in the MIPPO group than conventional open reduction group.

LEVEL OF EVIDENCE: Level IV. Retrospective study.

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