Effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DONG Wenwei ¹ , LIAN Weijie ² , MAO Haijiao ¹ , YAO Liwei ¹ , WU Zeting ¹

1. Department of Traumatic Orthopaedics, the First Affiliated Hospital of Ningbo University, Ningbo Zhejiang, 315000, P. R. China;
2. The Affiliated Hospital of Medical School, Ningbo University, Ningbo Zhejiang, 315000, P. R. China;

Corresponding author：

DONG Wenwei, Email: dongwwlq@163.com

Keywords：

Minimally invasive surgery; mid-shaft clavicle fracture; locking plate; internal fixation

DOI：

10.7507/1002-1892.202404037

Video：

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Objective To explore effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures. Methods Between October 2022 and August 2023, 28 patients with mid-shaft clavicle fractures were treated by minimally invasive internal fixation with locking plates. There were 10 males and 18 females with a mean age of 46.2 years (range, 18-74 years). The fractures were caused by traffic accident in 16 patients, sports-related injury in 7 patients, and other injuries in 5 patients. According to Robinson classiﬁcation, the fractures were classified as type 2A1 in 1 case, type 2A2 in 6 cases, type 2B1 in 15 cases, and type 2B2 in 6 cases. The interval between fracture and operation ranged from 5 hours to 21 days (median, 1.0 days). The pain visual analogue scale (VAS) score was 8.1±1.6. The VAS score at 3 days after operation and the occurrence of complications after operation were recorded. During follow-up, X-ray films were re-examined to observe the healing of the fracture; the shoulder joint function was evaluated according to the Constant-Murley score at 6 months, and the length of the incision scar (total length of the distal and proximal incisions) was measured. Results All operations were successfully completed without any subclavian vascular or nerve damage. All incisions healed by first intention. The VAS score was 1.2±0.7 at 3 days after operation, and there was a significant difference in VAS score between pre- and post-operation (t=8.704, P<0.001). At 1 week after operation, the patient’s shoulder was basically painless, and they resumed normal life. All patients were followed up 12-20 months (mean, 13.3 months). X-ray films showed that the bone callus began to form at 2-4 months after operation (mean, 2.7 months). There was no delayed healing or non healing of the fracture, and no loosening or fracture of the internal fixators during follow-up. At 6 months after operation, the mean total incision length was 1.5 cm (range, 1.1-1.8 cm); no patient complained of numbness or paresthesia on subclavicular region or anterior chest wall. The Constant-Murley score of shoulder joint function was 93-100 (mean, 97.6). Conclusion Minimally invasive internal fixation with locking plates is a good surgical method for treating mid-shaft clavicle fractures, with simple operation, minimal trauma, good postoperative results, and high satisfaction.

Citation： DONG Wenwei, LIAN Weijie, MAO Haijiao, YAO Liwei, WU Zeting. Effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 947-953. doi: 10.7507/1002-1892.202404037 Copy

1.	Guerra E, Previtali D, Tamborini S, et al. Midshaft clavicle fractures: surgery provides better results as compared with nonoperative treatment: a meta-analysis. Am J Sports Med, 2019, 47(14): 3541-3551.
2.	Axelrod DE, Ekhtiari S, Bozzo A, et al. What is the best evidence for management of displaced midshaft clavicle fractures? A systematic review and network meta-analysis of 22 randomized controlled trials. Clin Orthop Relat Res, 2020, 478(2): 392-402.
3.	von Rüden C, Rehme-Röhrl J, Augat P, et al. Evidence on treatment of clavicle fractures. Injury, 2023, 54 Suppl 5: 110818. doi: 10.1016/j.injury.2023.05.049.
4.	Wolf S, Chitnis AS, Manoranjith A, et al. Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England. BMC Musculoskelet Disord, 2022, 23(1): 135. doi: 10.1186/s12891-022-05075-5.
5.	Sliepen J, Hoekstra H, Onsea J, et al. Treatment and outcome of fracture-related infection of the clavicle. Injury, 2023, 54(8): 110910. doi: 10.1016/j.injury.2023.110910.
6.	Hoogervorst P, van Dam T, Verdonschot N, et al. Functional outcomes and complications of intramedullary fixation devices for midshaft clavicle fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2020, 21(1): 395. doi: 10.1186/s12891-020-03256-8.
7.	Hill BW, Thomas CN, Schroder LK, et al. Structures endangered during minimally invasive plate osteosynthesis of the upper extremity. J Am Acad Orthop Surg, 2021, 29(16): e782-e793.
8.	Mendes Junior AF, Mota Neto JD, Oppe IG, et al. Surgical treatment of comminuted midshaft clavicle fracture by minimally invasive technique: description and preliminary results. Rev Bras Ortop (Sao Paulo), 2021, 56(4): 490-496.
9.	Devkota P, Acharya BM, Pradhan NMS, et al. Minimally-invasive plate osteosynthesis for clavicle fractures. Rev Bras Ortop (Sao Paulo), 2021, 57(2): 295-300.
10.	赵志辉, 冯雪峰, 王永清, 等. 弹性带锁髓内钉固定治疗锁骨中段骨折. 中华骨科杂志, 2022, 42(3): 164-171.
11.	董文伟, 史增元, 刘振新, 等. 胫骨骨折闭合复位手术架的设计与临床应用. 中国修复重建外科杂志, 2013, 27(11): 1281-1285.
12.	Dong WW, Shi ZY, Liu ZX, et al. Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures. Chin J Traumatol, 2016, 19(6): 348-352.
13.	董文伟, 毛海蛟, 姚立炜, 等. 胫骨牵引架在股骨远端骨折经皮微创钢板内固定中的应用. 中华骨科杂志, 2018, 38(22): 1357-1365.
14.	董文伟, 赵翔, 毛海蛟, 等. 锁骨远端解剖型锁定钢板微创内固定治疗锁骨中外1/3 骨折. 中国骨伤, 2019, 32(1): 28-32.
15.	董文伟, 毛海蛟, 史增元, 等. 锁定钢板经皮微创内固定治疗锁骨中段骨折. 中华骨科杂志, 2020, 40(23): 1601-1611.
16.	Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg (Br), 1998, 80(3): 476-484.
17.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, 214: 160-164.
18.	Pradel S, Brunaud M, Coulomb R, et al. Less than 1.5 cm shortening in clavicle midshaft fracture has long-term functional impact. Orthop Traumatol Surg Res, 2023, 109(5): 103590. doi: 10.1016/j.otsr.2023.103590.
19.	Tamaoki MJS, Matsunaga FT, Costa ARFD, et al. Treatment of displaced midshaft clavicle fractures: figure-of-eight harness versus anterior plate osteosynthesis: a randomized controlled trial. J Bone Joint Surg (Am), 2017, 99(14): 1159-1165.
20.	Huang D, Deng Y, Cheng J, et al. Comparison of patient reported outcomes following clavicle operative fixation using supraclavicular nerve sparing and supraclavicular nervesacrificing techniques—A cohort study. Injury, 2021, 52(3): 501-505.
21.	Steinmetz G, Conant S, Bowlin B, et al. The anatomy of the clavicle and its in vivo relationship to the vascular structures: A 2D and 3D reconstructive study using CT scans. J Orthop Trauma, 2020, 34(1): e14-e19.

1. Guerra E, Previtali D, Tamborini S, et al. Midshaft clavicle fractures: surgery provides better results as compared with nonoperative treatment: a meta-analysis. Am J Sports Med, 2019, 47(14): 3541-3551.
2. Axelrod DE, Ekhtiari S, Bozzo A, et al. What is the best evidence for management of displaced midshaft clavicle fractures? A systematic review and network meta-analysis of 22 randomized controlled trials. Clin Orthop Relat Res, 2020, 478(2): 392-402.
3. von Rüden C, Rehme-Röhrl J, Augat P, et al. Evidence on treatment of clavicle fractures. Injury, 2023, 54 Suppl 5: 110818. doi: 10.1016/j.injury.2023.05.049.
4. Wolf S, Chitnis AS, Manoranjith A, et al. Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England. BMC Musculoskelet Disord, 2022, 23(1): 135. doi: 10.1186/s12891-022-05075-5.
5. Sliepen J, Hoekstra H, Onsea J, et al. Treatment and outcome of fracture-related infection of the clavicle. Injury, 2023, 54(8): 110910. doi: 10.1016/j.injury.2023.110910.
6. Hoogervorst P, van Dam T, Verdonschot N, et al. Functional outcomes and complications of intramedullary fixation devices for midshaft clavicle fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2020, 21(1): 395. doi: 10.1186/s12891-020-03256-8.
7. Hill BW, Thomas CN, Schroder LK, et al. Structures endangered during minimally invasive plate osteosynthesis of the upper extremity. J Am Acad Orthop Surg, 2021, 29(16): e782-e793.
8. Mendes Junior AF, Mota Neto JD, Oppe IG, et al. Surgical treatment of comminuted midshaft clavicle fracture by minimally invasive technique: description and preliminary results. Rev Bras Ortop (Sao Paulo), 2021, 56(4): 490-496.
9. Devkota P, Acharya BM, Pradhan NMS, et al. Minimally-invasive plate osteosynthesis for clavicle fractures. Rev Bras Ortop (Sao Paulo), 2021, 57(2): 295-300.
10. 赵志辉, 冯雪峰, 王永清, 等. 弹性带锁髓内钉固定治疗锁骨中段骨折. 中华骨科杂志, 2022, 42(3): 164-171.
11. 董文伟, 史增元, 刘振新, 等. 胫骨骨折闭合复位手术架的设计与临床应用. 中国修复重建外科杂志, 2013, 27(11): 1281-1285.
12. Dong WW, Shi ZY, Liu ZX, et al. Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures. Chin J Traumatol, 2016, 19(6): 348-352.
13. 董文伟, 毛海蛟, 姚立炜, 等. 胫骨牵引架在股骨远端骨折经皮微创钢板内固定中的应用. 中华骨科杂志, 2018, 38(22): 1357-1365.
14. 董文伟, 赵翔, 毛海蛟, 等. 锁骨远端解剖型锁定钢板微创内固定治疗锁骨中外1/3 骨折. 中国骨伤, 2019, 32(1): 28-32.
15. 董文伟, 毛海蛟, 史增元, 等. 锁定钢板经皮微创内固定治疗锁骨中段骨折. 中华骨科杂志, 2020, 40(23): 1601-1611.
16. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg (Br), 1998, 80(3): 476-484.
17. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, 214: 160-164.
18. Pradel S, Brunaud M, Coulomb R, et al. Less than 1.5 cm shortening in clavicle midshaft fracture has long-term functional impact. Orthop Traumatol Surg Res, 2023, 109(5): 103590. doi: 10.1016/j.otsr.2023.103590.
19. Tamaoki MJS, Matsunaga FT, Costa ARFD, et al. Treatment of displaced midshaft clavicle fractures: figure-of-eight harness versus anterior plate osteosynthesis: a randomized controlled trial. J Bone Joint Surg (Am), 2017, 99(14): 1159-1165.
20. Huang D, Deng Y, Cheng J, et al. Comparison of patient reported outcomes following clavicle operative fixation using supraclavicular nerve sparing and supraclavicular nervesacrificing techniques—A cohort study. Injury, 2021, 52(3): 501-505.
21. Steinmetz G, Conant S, Bowlin B, et al. The anatomy of the clavicle and its in vivo relationship to the vascular structures: A 2D and 3D reconstructive study using CT scans. J Orthop Trauma, 2020, 34(1): e14-e19.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures

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