title: Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating.
abstract: BACKGROUND
  The minimally invasive plate osteosynthesis procedure has been widely applied for long-bone fixations; however, this technique is not commonly used for clavicular midshaft fractures. In this study, we introduced this technique for midshaft clavicular fractures using superior anatomic locking plates and evaluated its clinical and radiographic outcomes.
  
  
  METHODS
  From June 2013 to July 2014, 15 patients with acute midshaft clavicular fractures were treated with the minimally invasive plate osteosynthesis technique using a 3.5-mm clavicular superior anatomic locking plate. Anteroposterior plain X-ray images of the clavicle were taken at 4-week intervals until union was observed. The last clinical follow-up assessments were performed postoperatively at a mean of 16.54 months (range, 10-23 months). In addition, for clinical evaluations, the Constant score and the Disability of the Arm, Shoulder and Hand score were assessed.
  
  
  RESULTS
  The average operative time was 60.2 ± 20.1 minutes (range, 40-80 minutes), with blood loss of 25 ± 5 mL (range, 20-30 mL) during the operation. The mean union time for the patients was 10.1 ± 1.4 weeks (range, 8-12 weeks), and no delayed union or nonunion was observed. There were no major complications, including infections, plate breakages, or neurovascular injuries. No skin irritation was observed, and only 2 patients felt local incision numbness. All patients obtained satisfactory shoulder functions. The mean Constant score was 99 ± 1.8 (range, 95-100), and the mean Disability of the Arm, Shoulder and Hand score was 3.8 ± 2.9 (range, 0-10) at the last control visit.
  
  
  CONCLUSIONS
  The minimally invasive plate osteosynthesis procedure that was introduced in this study for midshaft clavicular fractures with superior anatomic locking plate is a reproducible procedure and an alternative to conventional operative methods.
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Yuelei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: junxu19781214@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Changqing
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Yuqiang
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D011859:Radiography; D012785:Shoulder Joint / Q000503:physiopathology; D013997:Time Factors
keywords: MIPO; Midshaft clavicular fracture; anatomic locking plate