Minimally invasive plate osteosynthesiswith the application of a superior anatomic locking plate; is it a suitable treatment approach for AO-OTA Type B clavicular midshaft fractures?

The minimally invasive osteosynthesis technique has gained attention in fracture treatment in recent years. The aim of this study was to evaluate the effects of the minimally invasive plate osteosynthesis (MIPO) technique, on clinical and radiological outcomes in the surgical treatment of AO-OTA Type B (wedge) clavicular midshaft fractures. This prospective study included twenty-three patients who were diagnosed with acute clavicular midshaft fracture where surgical intervention was indicatedand MIPO was performed between February 2014 and April 2016.Exclusion criteria were patients with non-displaced fractures, pathological fractures, open fractures, cases where theindex trauma was three weeks ago, or those with concomitant neurovascular injuries.The patients comprised of 16 males and 7 females with a mean age of 36.5 years (range, 18-65 years).The mean time from trauma to surgery was 6.1 days (range, 3-12 days).The mean follow-up period was 15.3 months (range: 12-18 months). The mean duration of surgery was 65.5 mins (range: 50-80 mins). Anatomic reduction was obtained in 11 (47%) patients, of whom 7 were Type B1, 4 were Type B2, and 1 was Type B3. The mean time to union was found to be 15.9 weeks (range: 10-24 weeks). After union was confirmed, the mean Constant Murley score was 83 (range: 68-92) and the mean UCLA score was 29.95 (range: 23-34). The mean proportional length difference in the clavicle was 0.32% (range:-0.55 to +1.63).There was no statistically significant difference for the Constant Murley score and UCLA score between patients with anatomic reduction achieved and not achieved (p=0.36, p=0.43 respectively). Osteosynthesis with a minimally invasive percutaneously applied plate (MIPO) could be a successful therapeutic option for the management of acute, displaced AO OTA Type B clavicular midshaft fractures.