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OBJECTIVE: One of the most common surgeries for mid-shaft clavicular fracture is an open reduction and internal fixation with plate and screws. When using a conventional technique of plate fixation, a long incision is used, compromising blood supply to the bone and soft tissues. This can result in delayed or nonunion, skin complications, painful scarring, infection and paraesthesia inferior to the clavicle. This study reports on a minimally invasive plate osteosynthesis with separated vertical incisions. The aim is to evaluate radiographic and clinical outcomes in mid-shaft clavicular fractures.  MATERIALS AND METHODS: From January 2011 to July 2013, eight cases were operated using the technique. Fracture reduction was arrived at by indirect manipulation with a postural reduction under fluoroscopic guidance. Vertical incisions were done proximally and distally. We evaluated the clinical and radiographic results immediately postoperation and at 2, 4, 8 weeks and thereafter every 4 weeks postoperative until union was achieved.  RESULTS: AO Type 15-B2.2 was the most common: all fractures healed within a mean period of 13.8 weeks (range 11-18 weeks). All patients showed good shoulder function, with a mean disabilities of the arm, shoulder and hand (DASH) score of 6.8 (range 4-15.3) at six months. There were no complications, except bending of an implant in one patient. However this patient achieved a bone union with good function. There was no numbness around the clavicle in this series. Average operative time was 128 minutes. Fluoroscopic exposure time was 29.5 seconds.  CONCLUSION: We propose vertical incisions as an approach for plate and screws application for this MIPO technique. This presented technique is good, not only with regards to appearance but also in avoiding any associated complications. We propose this technique as an option for minimally invasive plate osteosynthesis (MIPO) for mid-shaft clavicular fractures.

the bangkok medical journal

Preliminary Report of Minimally Invasive Plate Osteosynthesis with Vertical Incisions for Mid-shaft Clavicular Fractures: a Surgical Technique and its Results