Minimally invasive plate osteosynthesis (MIPO) with mini-open technique versus open reduction and internal fixation (ORIF) in the treatment of displaced midclavicular fracture: a retrospective study.

Introduction: Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) for the treatment of different long bone fractures. This retrospective study aimed to compare MIPO with the mini-open technique versus conventional ORIF for the treatment of displaced midshaft clavicular fractures. We hypothesized that this technique would improve supraclavicular nerve (SCN) injury-related numbness, decrease surgical incision, blood loss, thick scar, and overall patient satisfaction.

Methods: We retrospectively reviewed 45 cases of displaced midclavicular fractures that were treated surgically at our hospital between December 2020 and June 2022. There were 20 (44.4%) patients using mini-open with MIPO and 25 (55.6%) patients using conventional ORIF treated with anatomical locking plate guided by C-arm X-ray machine. Comparison of surgical indices (operative time, blood loss, incision length, and fluoroscopy exposure times) and postoperative complications (anterior chest wall numbness, area of numbness, superficial infection, hardware irritation, and scar satisfaction) were compared between the two groups. In addition, Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Score (CMS), and overall surgical satisfaction were compared between the two groups.

Results: The mini-open MIPO group had statistically significant benefits on the basis of surgical length, blood loss, visual analog scale (VAS) score on the first and third postoperative days, and length of hospital stay. Major complications, such as SCN-related numbness, area of numbness, and thick scarring, were greatly reduced. The cosmetic and overall surgical satisfaction was greater in MIPO. Conversely, hardware irritation, surgical infection, and numbness were more frequent in the ORIF group. There were no significant differences in DASH and CMS scores between the groups at the 12-month follow-up.

Conclusions: MIPO is a more effective and safer modern surgical method than ORIF for displaced midclavicle fractures. Improvements in operative indices, postoperative numbness owing to SCN injury, surgical incision, and cosmesis satisfaction were achieved.

Level Of Evidence: Level III, retrospective case-control study.