Comparative Analysis of Minimally Invasive Versus Open Reduction Plate Osteosynthesis Using a Superior Clavicle Plate in Clavicle Shaft Fractures

Abstract

Background: Clavicle fractures are a common type of fracture, and the treatment of clavicle shaft fractures involves various implant options and approaches. This study aimed to compare the clinical and radiological outcomes of surgical treatment using the minimally invasive technique versus open reduction plate osteosynthesis with a superior clavicle plate featuring lateral extension for clavicle shaft fractures. Methods: This retrospective case-control study included 70 consecutive patients who underwent surgery for displaced clavicle shaft fractures between March 2022 and August 2023: group M (n = 20), which underwent a minimally invasive technique, and group C (n = 41), which underwent open reduction plate osteosynthesis. Clinical outcomes, visual analog scale scores, Constant scores, and hypoesthesia in the area supplied by the superior clavicular nerve were assessed 1 year postoperatively. The time to clinical bone union was also measured from surgery to tenderness resolution. Radiological evaluation included assessment of the number of fracture fragments, measurement of the fracture gap interval, and determination of the time to radiographic bone union. Intraoperative exposure time using the C-arm was also recorded. Results: We observed no significant differences in clinical outcomes and the bone union rates between the 2 groups. However, compared to group C, group M showed a shorter operation time (p = 0.004), less blood loss (p < 0.001), and a lower incidence of hypoesthesia (p < 0.001). Compared to group C, group M had a longer time to achieve radiologic bone union (p < 0.001); however, there was no difference in the clinical bone union time between the 2 groups. Regarding complications, there were 9 cases of hypoesthesia in group C and 1 case of nonunion in group M. Conclusions: This minimally invasive technique, using a superior clavicle plate with lateral extension for clavicle shaft fractures, achieved clinical outcomes and bone union rates that were comparable to those of open reduction plate osteosynthesis, while also offering the advantages of shorter operation time, reduced blood loss, and a lower risk of hypoesthesia.