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Minimally invasive plate osteosynthesis (MIPO) in AO/OTA type B displaced clavicle fractures

  • R. S. Kundangar
  • S. P. Mohanty
  • N. S. Bhat
Original Article
  • 9 Downloads

Abstract

Introduction

Open reduction and plate fixation is known to reduce chances of malunion and symptomatic nonunion in displaced middle-third clavicle fractures. However, this treatment modality is also associated with several complications, such as hardware irritation, numbness around the surgical scar, infection, nonunion and implant failure. The minimally invasive plate osteosynthesis (MIPO) technique may reduce these complications.

Objective

To study clinical, radiological and functional outcomes of MIPO in AO/OTA type B displaced clavicle fractures and report any complications.

Materials and methods

A total of 22 patients underwent internal fixation of acute displaced AO/OTA type B clavicle fractures from Jan 2014 to Dec 2015 by MIPO using locking compression plates. Patients were followed up at a regular interval and assessed clinically and radiologically. The clavicle length difference was measured. Functional assessment was done at the end of 2 year using constant shoulder score (CSS) and disability of the arm, shoulder and hand score (Quick DASH) and complications if any were noted.

Results

All fractures united at a mean of 12.5 weeks. One (4.5%) patient had numbness around the surgical scar. None of the patients had wound-related complications. In four patients, hardware irritation was noted. The difference in clavicle length was not significant. All patients had excellent CSS and Quick DASH score at the final follow-up.

Conclusion

Internal fixation of displaced AO/OTA type B clavicle fractures by MIPO showed high fracture union rates and good functional outcomes.

Keywords

Minimally invasive plate osteosynthesis (MIPO) Displaced clavicle fractures Locking compression plate 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    McKee MD (2015) Clavicle fractures. In: Court-Brown CM (ed) Rockwood and green’s fractures in adults, 8th edn. Wolters Kluwer, Alphen aan den Rijn, pp 1427–1473Google Scholar
  2. 2.
    Postacchini F, Gumina S, De Santis P et al (2002) Epidemiology of clavicle fractures. J Shoulder Elb Surg 11:452–456CrossRefGoogle Scholar
  3. 3.
    Rowe CR (1968) An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 58:29–42CrossRefGoogle Scholar
  4. 4.
    Geddes CR, McKee MD (2013) Clavicle fractures. In: Sethi MK (ed) Orthopedic traumatology: an evidence-based approach. Springer, New York, pp 87–102CrossRefGoogle Scholar
  5. 5.
    Postacchini R, Gumina S, Farsetti P et al (2010) Long-term results of conservative management of midshaft clavicle fracture. Int Orthop 34:731–736CrossRefGoogle Scholar
  6. 6.
    Andersen K, Jensen PO, Lauritzen J (1987) Treatment of clavicular fractures: figure-of-eight bandage versus a simple sling. Acta Orthop Scand 58:71–74CrossRefGoogle Scholar
  7. 7.
    Canadian Orthopaedic Trauma Society (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multicenter, randomized clinical trial. J Bone Joint Surg Am 89:1–10CrossRefGoogle Scholar
  8. 8.
    Nowak J, Holgersson M, Larsson S (2004) Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elb Surg 13(5):479–486CrossRefGoogle Scholar
  9. 9.
    Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79(4):537–539CrossRefGoogle Scholar
  10. 10.
    Robinson CM et al (2013) Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg 95(17):1576–1584CrossRefGoogle Scholar
  11. 11.
    Böstman O, Manninen M, Pihlajamäki H (1997) Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 43(5):778–783CrossRefGoogle Scholar
  12. 12.
    Duncan SF, Sperling JW, Steinmann S (2005) Infection after clavicle fractures. Clin Orthop Relat Res 439:74–78CrossRefGoogle Scholar
  13. 13.
    Millett PJ, Hurst JM, Horan MP, Hawkins RJ (2011) Complications of clavicle fractures treated with intramedullary fixation. J Shoulder Elb Surg 20(1):86–91CrossRefGoogle Scholar
  14. 14.
    Jung GH, Park CM, Kim JD (2013) Biologic fixation through bridge plating for comminuted shaft fracture of the clavicle: technical aspects and prospective clinical experience with a minimum of 12-month follow-up. Clin Orthop Surg 5:327–333CrossRefGoogle Scholar
  15. 15.
    Lee HJ et al (2013) Percutaneous plating for comminuted midshaft fractures of the clavicle: a surgical technique to aid the reduction with nail assistance. Injury 44:465–470CrossRefGoogle Scholar
  16. 16.
    Sohn HS, Kim BY, Shin SJ (2013) A surgical technique for minimally invasive plate osteosynthesis of clavicular midshaft fractures. J Orthop Trauma 27:92–96CrossRefGoogle Scholar
  17. 17.
    Sohn HS, Shin SJ, Kim BY (2011) Minimally invasive plate osteosynthesis using anterior–inferior plating of clavicular midshaft fractures. Arch Orthop Trauma Surg 132:239–244CrossRefGoogle Scholar
  18. 18.
    March JL et al (2007) Orthopaedic trauma association classification, database and outcomes committee. Fracture and dislocation classification compendium 2007. J Orthop Trauma 21(10):S72–S74Google Scholar
  19. 19.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  20. 20.
    Fabre T, Piton C, Leclouerec G, Gervais-Delion F, Durandeau A (1999) Entrapment of the suprascapular nerve. J Bone Joint Surg Br 81(3):414–419CrossRefGoogle Scholar
  21. 21.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med 29(6):602–608CrossRefGoogle Scholar
  22. 22.
    Sohn HS (2015) Comparison between open plating versus minimally invasive plate osteosynthesis for displaced clavicular shaft fractures. Injury 46(1):1577–1584CrossRefGoogle Scholar
  23. 23.
    Jiang H, Qu W (2012) Operative treatment of clavicle midshaft fracture using locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res 98:666–671CrossRefGoogle Scholar
  24. 24.
    Zhang Y, Xu J, Zhang C, Sun Y (2016) Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plate. J Shoulder Elb Surg 25:7–12CrossRefGoogle Scholar
  25. 25.
    Lazarides S, Zafiropoulos G (2006) Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elb Surg 15(2):191–194CrossRefGoogle Scholar
  26. 26.
    Tyler Nathe MD, Susan Tseng MD, Brad Yoo MD (2011) Supraclavicular nerve anatomy at the clavicle. Clin Orthop Relat Res 469(3):890–894CrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics, Kasturba Medical College, ManipalManipal Academy of Higher EducationManipalIndia

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