Clavicle Fracture: MIPO Superior Fixation Technique
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Published:
Dec 26, 2024
Keywords:
Fracture, clavicle, MIPO, nerve injury
Main Article Content
Abstract
Introduction: Since Neer’s foundational work, the superiority of surgical treatment over conservative management for displaced clavicle fractures has been established. However, open techniques carry risks such as sensory nerve injury, stretching, and painful scarring. The MIPO (minimally invasive plate osteosynthesis) technique may mitigate these complications. This retrospective series evaluates our experience with closed, displaced, midshaft clavicle fractures, describes the surgical technique with emphasis on the approach, and presents functional outcomes.
Material and Methods: We retrospectively analyzed 32 patients (28 men [87.5%] and 4 women [12.5%]) with closed, simple, or comminuted fractures of the middle third of the clavicle treated surgically between January 2021 and March 2023. The average follow-up was 19 months (range 14–25), and the mean patient age was 32 years. Exclusion criteria included patients under 16 years old, associated injuries, and significant comorbidities. Functional outcomes were assessed using the ASES and the visual analog scale (VAS) for pain.
Results: Surgery was performed within 3 days of injury, and radiological consolidation occurred at an average of 15.6 weeks. The mean modified Constant-Murley score was 88.34, the mean ASES score was 83.8, and the mean VAS pain score was 0.5. No cases of subclavicular hypesthesia or painful scarring were reported.
Conclusion: This technique achieved fracture consolidation and full range of motion while minimizing complications. The MIPO approach, with its simple and reproducible parameters, can be considered a safe option.
Material and Methods: We retrospectively analyzed 32 patients (28 men [87.5%] and 4 women [12.5%]) with closed, simple, or comminuted fractures of the middle third of the clavicle treated surgically between January 2021 and March 2023. The average follow-up was 19 months (range 14–25), and the mean patient age was 32 years. Exclusion criteria included patients under 16 years old, associated injuries, and significant comorbidities. Functional outcomes were assessed using the ASES and the visual analog scale (VAS) for pain.
Results: Surgery was performed within 3 days of injury, and radiological consolidation occurred at an average of 15.6 weeks. The mean modified Constant-Murley score was 88.34, the mean ASES score was 83.8, and the mean VAS pain score was 0.5. No cases of subclavicular hypesthesia or painful scarring were reported.
Conclusion: This technique achieved fracture consolidation and full range of motion while minimizing complications. The MIPO approach, with its simple and reproducible parameters, can be considered a safe option.
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How to Cite
Fazzone, F., Garay, R., Focaraccio, S., Martínez, C. E., & Tornatore Garrido, Ítalo A. A. (2024). Clavicle Fracture: MIPO Superior Fixation Technique. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(6), 562-572. https://doi.org/10.15417/issn.1852-7434.2024.89.6.1946
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Clinical Research
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References
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2,144 fractures. J Orthop Trauma 2005;19(7):504-7. https://doi.org/10.1097/01.bot.0000172287.44278.ef
4. Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 1997;43(5):778-83. https://doi.org/10.1097/00005373-199711000-00008
5. Liu PC, Hsieh CH, Chen JC, Lu CC, Chuo CY, Chien SH. Infection after surgical reconstruction of a clavicle
fracture using a reconstruction plate: a report of seven cases. Kaohsiung J Med Sci 2008;24(1):45-9.
https://doi.org/10.1016/s1607-551x(08)70073-1
6. Frigg A, Rillmann P, Perren T, Gerber M, Ryf C. Intramedullary nailing of clavicular midshaft fractures with the
titanium elastic nail problems and complications. Am J Sports Med 2009;37(2):352-9. https://doi.org/10.1177/0363546508328103
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8. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 2005;36(4):530-8.
https://doi.org/10.1016/j.injury.2004.05.036
9. Krettek C, Schandelmaier P, Miclau T, Tscherne H. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 1997;28(Suppl 1):20-30.
https://doi.org/10.1016/s0020-1383(97)90112-1
10. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior–inferior plating of clavicular
midshaft fractures. Arch Orthop Trauma Surg 2012;132:239-44. https://doi.org/10.1007/s00402-011-1410-6
11. Havet E, Duparc F, Tobenas-Dujardin AC, Muller JM, Fréger P. Morphometric study of the shoulder and subclavicular innervation by the intermediate and lateral branches of supraclavicular nerves. Surg Radiol Anat
2007;29:605-10. https://doi.org/10.1007/s00276-007-0258-5
12. Gómez D, Dainotto T, Moya D, Patiño JM. Traducción y adaptación transcultural del Constant-Murley Score al
español de la Argentina. Rev Asoc Argent Ortop Traumatol 2022;87(4):579-92. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1491
13. Martínez-Cano JP, Llinás PJ, Escobar SS, López R, Caicedo Álvaro, Herrera G. Validación de la versión en español para Colombia de la escala ASES. Artroscopia [Internet] 2022;29(1): Disponible en:
https://revistaartroscopia.com.ar/index.php/revista/article/view/221
14. Kang H, Song JK, Rho JY, Lee J, Choi J, Choi S. Minimally invasive plate osteosynthesis (MIPO) for mid-shaft
fracture of the tibia (AO/OTA classification 42): A retrospective study. Ann Med Surg (Lond) 2020;60:408-12.
https://doi.org/10.1016/j.amsu.2020.11.033
15. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R. Effect of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg 2002;11(5):452-67.
https://doi.org/10.1067/mse.2002.125805
16. Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A. Biomechanical evaluation of clavicle fracture
plating technique: does a locking plate provide improved stability? J Orthop Trauma 2008;22(4):241-7.
https://doi.org/10.1097/bot.0b013e31816c7bac
17. Basamania CJ, Rockwood CA. Fractures of the clavicle. En: Rockwood CA (ed.) The shoulder, 4th ed. Philadelphia: WB Saunders; 2008, p. 423-8.
18. Bleeker NJ, van Veelen NM, van de Wall BJM, Sierevelt IN, Link BC, Babst R, et al. MIPO vs. intra-medullary
nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients. Eur J Trauma Emerg Surg 2022;48(5):3683-91. https://doi.org/10.1007/s00068-021-01836-4
19. Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the
femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33(4):1119-26.
https://doi.org/10.1007/s00264-008-0603-2
20. You JM, Wu YS, Wang Y. Comparison of post-operative numbness and patient satisfaction using minimally invasive plate osteosynthesis or open plating for acute displaced clavicular shaft fractures. Int J Surg 2018;56:21-5. https://doi.org/10.1016/j.ijsu.2018.06.007
2002;11(5):452-6. https://doi.org/10.1067/mse.2002.126613
2. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor
results. J Bone Joint Surg Br 1997;79(4):537-9. https://doi.org/10.1302/0301-620x.79b4.7529
3. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft fractures: systemic review of
2,144 fractures. J Orthop Trauma 2005;19(7):504-7. https://doi.org/10.1097/01.bot.0000172287.44278.ef
4. Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 1997;43(5):778-83. https://doi.org/10.1097/00005373-199711000-00008
5. Liu PC, Hsieh CH, Chen JC, Lu CC, Chuo CY, Chien SH. Infection after surgical reconstruction of a clavicle
fracture using a reconstruction plate: a report of seven cases. Kaohsiung J Med Sci 2008;24(1):45-9.
https://doi.org/10.1016/s1607-551x(08)70073-1
6. Frigg A, Rillmann P, Perren T, Gerber M, Ryf C. Intramedullary nailing of clavicular midshaft fractures with the
titanium elastic nail problems and complications. Am J Sports Med 2009;37(2):352-9. https://doi.org/10.1177/0363546508328103
7. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures—a randomized, controlled, clinical trial. J Orthop Trauma 2009;23(2):106-12. https://doi.org/10.1097/bot.0b013e318190cf88
8. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 2005;36(4):530-8.
https://doi.org/10.1016/j.injury.2004.05.036
9. Krettek C, Schandelmaier P, Miclau T, Tscherne H. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 1997;28(Suppl 1):20-30.
https://doi.org/10.1016/s0020-1383(97)90112-1
10. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior–inferior plating of clavicular
midshaft fractures. Arch Orthop Trauma Surg 2012;132:239-44. https://doi.org/10.1007/s00402-011-1410-6
11. Havet E, Duparc F, Tobenas-Dujardin AC, Muller JM, Fréger P. Morphometric study of the shoulder and subclavicular innervation by the intermediate and lateral branches of supraclavicular nerves. Surg Radiol Anat
2007;29:605-10. https://doi.org/10.1007/s00276-007-0258-5
12. Gómez D, Dainotto T, Moya D, Patiño JM. Traducción y adaptación transcultural del Constant-Murley Score al
español de la Argentina. Rev Asoc Argent Ortop Traumatol 2022;87(4):579-92. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1491
13. Martínez-Cano JP, Llinás PJ, Escobar SS, López R, Caicedo Álvaro, Herrera G. Validación de la versión en español para Colombia de la escala ASES. Artroscopia [Internet] 2022;29(1): Disponible en:
https://revistaartroscopia.com.ar/index.php/revista/article/view/221
14. Kang H, Song JK, Rho JY, Lee J, Choi J, Choi S. Minimally invasive plate osteosynthesis (MIPO) for mid-shaft
fracture of the tibia (AO/OTA classification 42): A retrospective study. Ann Med Surg (Lond) 2020;60:408-12.
https://doi.org/10.1016/j.amsu.2020.11.033
15. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R. Effect of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg 2002;11(5):452-67.
https://doi.org/10.1067/mse.2002.125805
16. Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A. Biomechanical evaluation of clavicle fracture
plating technique: does a locking plate provide improved stability? J Orthop Trauma 2008;22(4):241-7.
https://doi.org/10.1097/bot.0b013e31816c7bac
17. Basamania CJ, Rockwood CA. Fractures of the clavicle. En: Rockwood CA (ed.) The shoulder, 4th ed. Philadelphia: WB Saunders; 2008, p. 423-8.
18. Bleeker NJ, van Veelen NM, van de Wall BJM, Sierevelt IN, Link BC, Babst R, et al. MIPO vs. intra-medullary
nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients. Eur J Trauma Emerg Surg 2022;48(5):3683-91. https://doi.org/10.1007/s00068-021-01836-4
19. Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the
femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33(4):1119-26.
https://doi.org/10.1007/s00264-008-0603-2
20. You JM, Wu YS, Wang Y. Comparison of post-operative numbness and patient satisfaction using minimally invasive plate osteosynthesis or open plating for acute displaced clavicular shaft fractures. Int J Surg 2018;56:21-5. https://doi.org/10.1016/j.ijsu.2018.06.007