Electronic ISSN 2287-0237

VOLUME

PRELIMINARY REPORT OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS WITH VERTICAL INCISIONS FOR MID-SHAFT CLAVICULAR FRACTURES: A SURGICAL TECHNIQUE AND ITS RESULTS

SEPTEMBER 2014 - VOL.8 | ORIGINAL ARTICLE
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. 

Keywords:

fracture, osteosynthesis, mid-shaft clavicular fractures, minimally invasive plate osteosynthesis

MEDIA
Figure 1:
3.5 mm. Reconstruction LCP
Figure 2:
Anatomical Superior Clavicle LCP
Figure 3:
Preoperation template.
Figure 4:
Preoperation contouring of 3.5 mm., reconstruction LCP.
Figure 5:
Intraoperative setting of patient position and C-arm.
Figure 6:
Caudad tilting of C-arm.
Figure 7:
Cephalad tilting of C-arm.
Figure 8:
Preoperative x-ray.
Figure 9:
X-ray demonstration of Caudad tilting of C-arm.
Figure 10:
X-ray demonstration of Cephalad tilting of C-arm.
Figure 11:
Marking of anatomical landmarks before making incisions.
Figure 12:
Plate length and position identification under C-arm guidance.
Figure 13:
Vertical lateral skin incision and tunnelling technique.
Figure 14:
Insert the plate, reduce the fracture and temporary fix with K wires through the medial and lateral incision.
Figure 15:
The 3.5 cortical screws were used to pull the main fragments to the bone, as a reduction template.
Figure 16:
The amount of screws on each side is three screws.
Figure 17:
X-ray of both clavicles preoperatively.
Figure 18:
X-ray of both clavicles postoperatively, to compare the length of the normal and injured side.
Figure 19:
Postoperative x-ray in AP to monitor healing.
Figure 20:
MIPO technique with vertical incisions.
Figure 21:
Reconstruction LCP is too weak to fix clavicle in some cases such as heavy arm and larger body.
Figure 22:
After early ROM exercise, most of the patients had good function.
Preliminary Report of Minimally Invasive Plate Osteosynthesis with Vertical Incisions for Mid-shaft Clavicular Fractures:
a Surgical Technique and its Results
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