Operative treatment of clavicle midshaft fractures using a locking compression plate: Comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction

Jiang, Haiyue; Qü, Wei

doi:10.1016/j.otsr.2012.02.011

Cited by 57 publications

(62 citation statements)

References 32 publications

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“…Fifteen of these studies proved eligible for inclusion ( Figure 1). 5,10,[30][31][32][33][34][35][36][37][38][39][40][41][42] The overall agreement between the 2 reviewers for final eligibility was excellent (κ value = 0.94, 95% confidence interval [CI] 0.84-1). All 15 studies were published between 2007 and 2013; their characteristics are summarized in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…43 Five studies compared different operative implants. [37][38][39][40][41] One placebo-controlled trial managed all fractures nonoperatively. 42 Twelve studies were reported in English.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…5,10,[30][31][32][33][34][35][36][37]39,40 Eight studies were considered to be at low risk for attrition bias, 5,30,33,[35][36][37]40,42 6 were classified as high risk, 10,31,32,34,39,41 and 1 was judged as unclear. 38 Reporting bias was deemed high in 7 studies, 10,30,34,35,37,38,41 while 6 were unclear [31][32][33]39,40,42 and 2 were considered as low. 5,36 Agreement between reviewers in the assessment of methodologic quality was excellent (weighted κ value = 0.85).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

et al. 2015

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C lavicle fractures are common injuries, affecting about 22 000 Canadians each year and numbering 1.75 million fractures worldwide. [1][2][3][4][5][6] The majority of these fractures are located in the midshaft, accounting for about 80% of all clavicle fractures.1,2 Closed midshaft fractures were traditionally treated nonoperatively, a practice largely based on previous studies by Neer and Rowe. 7,8 In the last decade, evidence challenged the standard of nonoperative treatment, reporting high rates of nonunion (15%-20%), poor early function, and residual sequelae at 6 months following nonoperative management in up to 42% of patients.9 Small clinical trials that followed have fuelled a growing popularity to treat these fractures surgically with plates and screws or intramedullary devices; however, these procedures carry inherent surgical risks for infection, implant failure and hardware irritation requiring subsequent removal. 10,11 Whether surgery or a conservative approach is the optimal method of management for midshaft clavicle fractures is still an issue of debate. Several trials have compared operative and nonoperative approaches to treatment. In the last 5 years, a number of trials have also investigated various surgical techniques and the use of different implants. Previous reviews focused only on the operative versus nonoperative debate. 1,9,11,12 Our review adds to this body of literature by providing data from the largest and most recent trial. It also provides a summary of the evidence on surgical techniques for these injuries, as well as nonsurgical options.We performed a meta-analysis to determine the effect of operative and nonoperative interventions for treating acute displaced midshaft clavicle fractures on the risk of secondary operation and all complications and on long-term function. Background: The popularity of surgery for acute displaced midshaft clavicle fractures has been fuelled by early randomized controlled trials (RCTs) showing improved rates of radiographic union and perceived functional benefits compared with nonoperative approaches. We performed a meta-analysis to determine the effect of operative and nonoperative interventions on the risk of secondary operation and complications and on long-term function. Operative versus nonoperative interventions for common

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Section: Study Characteristicsmentioning

confidence: 99%

“…43 Five studies compared different operative implants. [37][38][39][40][41] One placebo-controlled trial managed all fractures nonoperatively. 42 Twelve studies were reported in English.…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

et al. 2015

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“…[23][24][25][26] Minimally invasive percutaneous plate osteosynthesis technique along with application of a locking plate has been recently introduced, offering an ideal combination in terms of bone fixation and soft-tissue sparing since periosteal stripping can be minimized to promote rapid union. 6,27) In this study, fractures were treated with an anatomical plate or locking plate, and union was achieved in all cases. We prefer open reduction and internal fixation over minimally invasive techniques since they allow for ease of access to the fracture site and precise reduction of complex fractures.…”

Section: Discussionmentioning

confidence: 99%

“…5) Treatment options for acute mid-shaft clavicle fractures include open reduction and internal fixation with plates as well as closed or open reduction and internal fixation with intramedullary (IM) pins, wires, or a nail. [6][7][8] Advantages of plate fixation are anatomical reduction, which enables immediate stabilization. Although high success rates of plate fixation have been achieved, reported complications of plate fixation include implant failure, implant prominence, nonunion as a result of extended periosteal stripping, and soft tissue damage.…”

Section: Introductionmentioning

confidence: 99%

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

Park

Kang

Kim³

et al. 2017

Clinics in Shoulder and Elbow

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Background: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. Methods: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. Results: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7-18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0-17 mm). The average UCLA score and Constant score were 33.6 (range: 25-35) and 92.5 (range: 65-100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. Conclusions: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.

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Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

Lenza

Faloppa

2015

Cochrane Database of Systematic Reviews

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There is very limited and low quality evidence available from randomised controlled trials regarding the effectiveness of different methods of surgical fixation of fractures and non-union of the middle third of the clavicle. The evidence from four ongoing trials is likely to inform practice for the comparisons of intramedullary versus plate fixation and anterior versus superior plates for acute fractures in a future update. Further randomised trials are warranted, but in order to optimise research effort, these should be preceded by research that aims to identify priority questions.

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Operative treatment of clavicle midshaft fractures using a locking compression plate: Comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction

Abstract: Level IV. Retrospective study.

Cited by 57 publications

References 32 publications

Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

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