A minimally invasive plate osteosynthesis technique along Langer's line of neck in the treatment of midclavicular comminuted fracture.

PURPOSE: This study aimed to introduce a minimally invasive plate osteosynthesis technique along Langer's lines for treating comminuted midshaft clavicular fractures and to evaluate its clinical and radiological outcomes.

METHODS

From February 2020 to January 2023, 66 patients with midclavicular comminution fractures were randomized to either a conventional surgery group or a minimally invasive surgery (MIPO) group. In the MIPO group, three minimal incisions were made along Langer's lines at the distal and proximal fracture ends and at the fracture site, and an anatomical locking plate was used for fixation. The operative duration, the total length of surgical incisions and the number of C-arm fluoroscopy during the procedures were recorded, respectively. All patients underwent follow-up, with clavicle X-rays to assess fracture union. Postoperative scar condition was assessed using the Vancouver Scar Scale (VSS), shoulder joint function with the Constant-Murley score, and overall upper limb function with the DASH score.

RESULTS

No statistically significant differences were observed in mean operative duration (60.52 ± 8.92 vs. 58.21 ± 7.85, P = 0.27) or the average number of intraoperative C-arm fluoroscopies (4.23 ± 0.91 vs. 3.89 ± 0.88, P = 0.13) between the MIPO and traditional groups. A statistically significant difference was found in incision length (6.52 ± 0.76 cm vs. 10.45 ± 0.93 cm, P < 0.05). The MIPO group demonstrated significantly shorter times to bone union (14.21 ± 2.62 weeks vs. 16.82 ± 3.24 weeks, P < 0.05) and return to normal activities (14.84 ± 3.12 weeks vs. 17.68 ± 3.56 weeks, P < 0.05) compared to the traditional group. The VSS scores vs. 4.23 ± 0.86 and 7.56 ± 0.98 (P < 0.05) for the MIPO and traditional groups, respectively. At one year postoperatively, the Constant-Murley scores were 94.6 ± 4.12 vs. 92.3 ± 4.86 (P < 0.05), and the DASH scores were 4.56 ± 0.96 vs. 6.45 ± 0.92 (P < 0.05) for the MIPO and traditional groups, respectively.

CONCLUSION

This MIPO technique achieves effective reduction and stabilization of the comminuted clavicular midshaft fractures without prolonging the surgical duration, while also taking into account the aesthetic quality of the incision and yielding favorable clinical outcomes.