Orthopedics

Feature Article 

A Comparison of Clinical and Radiological Outcomes of Minimally Invasive and Conventional Plate Osteosynthesis for Midshaft Clavicle Fractures

Joon Yub Kim, MD, PhD; Byung Chan Yoo, MD; Jong Pil Yoon, MD, PhD; Sung Jin Kang, MD; Seok Won Chung, MD, PhD

Abstract

Thirty patients with displaced midshaft clavicle fractures were prospectively enrolled in this study. Fifteen were randomly assigned to the minimally invasive plate osteosynthesis group and 15 to the conventional plate osteosynthesis group. Constant score, visual analog scale satisfaction score, operative time, scar length, and complications, including hypoesthesia, were evaluated at least 1 year postoperatively to determine functional outcomes and time to bone union as a radiological outcome. Factors related to bone union, including the gap interval between fracture fragments and the number of fracture fragments, were also evaluated. The Constant score and the visual analog scale satisfaction score were higher in the minimally invasive plate osteosynthesis group than in the conventional plate osteosynthesis group; however, there was no significant difference between the groups in these scores or in the time to bone union (all P>.05). Hypoesthesia was the only complication, and its incidence was not different between the groups (P=.249). However, operative time (52.33±13.87 vs 110.33±25.39 minutes, P<.001) and scar length (64.95±3.19 vs 99.39±15.98 mm, P<.001) were significantly shorter in the minimally invasive plate osteosynthesis group than in the conventional plate osteosynthesis group, respectively. In the minimally invasive plate osteosynthesis group, time to bone union was significantly correlated with the gap interval (P=.004) and the number of fracture fragments (P=.002). Minimally invasive plate osteosynthesis showed some superiority over conventional plate fixation for midshaft clavicle fractures, having a shorter operative time and scar length. The time to bone union was influenced by the reduction status and the number of fracture fragments in the minimally invasive plate osteosynthesis group. [Orthopedics. 2018; 41(5):e649–e654.]

Abstract

Thirty patients with displaced midshaft clavicle fractures were prospectively enrolled in this study. Fifteen were randomly assigned to the minimally invasive plate osteosynthesis group and 15 to the conventional plate osteosynthesis group. Constant score, visual analog scale satisfaction score, operative time, scar length, and complications, including hypoesthesia, were evaluated at least 1 year postoperatively to determine functional outcomes and time to bone union as a radiological outcome. Factors related to bone union, including the gap interval between fracture fragments and the number of fracture fragments, were also evaluated. The Constant score and the visual analog scale satisfaction score were higher in the minimally invasive plate osteosynthesis group than in the conventional plate osteosynthesis group; however, there was no significant difference between the groups in these scores or in the time to bone union (all P>.05). Hypoesthesia was the only complication, and its incidence was not different between the groups (P=.249). However, operative time (52.33±13.87 vs 110.33±25.39 minutes, P<.001) and scar length (64.95±3.19 vs 99.39±15.98 mm, P<.001) were significantly shorter in the minimally invasive plate osteosynthesis group than in the conventional plate osteosynthesis group, respectively. In the minimally invasive plate osteosynthesis group, time to bone union was significantly correlated with the gap interval (P=.004) and the number of fracture fragments (P=.002). Minimally invasive plate osteosynthesis showed some superiority over conventional plate fixation for midshaft clavicle fractures, having a shorter operative time and scar length. The time to bone union was influenced by the reduction status and the number of fracture fragments in the minimally invasive plate osteosynthesis group. [Orthopedics. 2018; 41(5):e649–e654.]

Clavicle fractures are relatively common and account for 2.6% of adult fractures and 35% of shoulder injuries.1–3 Approximately 80% of clavicle fractures occur in the midshaft.2,4 Conservative treatment for midshaft clavicle fractures can lead to favorable functional outcomes in most cases. However, operative treatment has gained popularity and consensus because of its low rates of malunion and nonunion and patients' early return to daily activities postoperatively.2,4 The most commonly performed surgery for midshaft clavicle fractures is open reduction and internal fixation using a plate and screws or conventional plate osteosynthesis.1,5 However, the conventional plate osteosynthesis technique may compromise blood supply to the periosteum and soft tissues and also cause delayed union or nonunion.4,6–10 In addition, this surgical technique can cause anterior chest numbness or hypoesthesia due to injury to the supraclavicular nerve branches.5,10,11 Furthermore, wide scars after the surgery might cause mental trauma, especially among young female patients.

Biological fixation via the minimally invasive plate osteosynthesis (MIPO) technique has been widely used recently in various areas of orthopedics. Minimally invasive plate osteosynthesis offers the advantage of minimal soft tissue dissection while preserving periosteal blood supply at the fracture site.12–14 Recent studies have reported favorable functional and radiological outcomes of MIPO for midshaft clavicle fractures.5,7,9,10,15,16 However, reduction might not be an easy process during MIPO for midshaft clavicle fractures. Furthermore, acceptable reduction of displaced fracture fragments could be difficult to achieve during MIPO. Additionally, studies comparing clinical and radiological outcomes of MIPO and conventional plate osteosynthesis for midshaft clavicle fractures are limited.5,10 The authors hypothesized that MIPO would have good functional outcomes similar to those of conventional plate osteosynthesis but that MIPO would be superior to conventional plate osteosynthesis regarding operative time, scar length, and incidence of complications. The purpose of this study was to determine the clinical and radiological outcomes of MIPO compared with conventional plate osteosynthesis for midshaft clavicle fractures. The authors also sought to verify the influence of reduction status on bone union among patients in the MIPO group.

Materials and Methods

This study received institutional review board approval. Informed consent was obtained from the patients.

Sample Size Calculation

Sample sizes were calculated based on a previous study of treatments for clavicular fractures that compared intramedullary nailing with plate osteosynthesis and proved the noninferiority of intramedullary nailing.17 On the basis of that study, 15 patients per group were required to have 80% power and a type I error level of 0.05 to detect a difference of 7.5 in the Constant score (the minimal clinically important difference).17 To allow up to a 20% loss to follow-up, a total of 36 patients needed to be enrolled.

Patient Enrollment

Forty-two consecutive patients with displaced midshaft clavicle fractures between March 2013 and January 2015 were included. The inclusion criteria for this study were midshaft clavicle fractures with complete displacement, marked shortening (>2 cm), or comminution. Workers' compensation cases (n=3), open fractures or refractures (n=1), and any concomitant upper extremity fracture on the ipsilateral side (n=2) were excluded. After application of the exclusion criteria, a total of 36 patients were enrolled in this study. The authors divided these patients into 2 groups—the MIPO group (group M; n=18) and the conventional plate osteosynthesis group (group C; n=18)— using a randomization program ( www.randomizer.org). Loss to follow-up occurred in 1 case in group M and 3 cases in group C. Two cases in group M were excluded because their operation was converted to conventional plate osteo-synthesis owing to failure of temporary reduction. Therefore, 15 patients were analyzed in each group (Figure 1). The demographics of the patients are summarized in Table 1.

Flowchart for patient enrollment. Abbreviation: MIPO, minimally invasive plate osteosynthesis.

Figure 1:

Flowchart for patient enrollment. Abbreviation: MIPO, minimally invasive plate osteosynthesis.

Demographics of the Minimally Invasive Plate Osteosynthesis (Group M) and Conventional Plate Osteosynthesis (Group C) Groups

Table 1:

Demographics of the Minimally Invasive Plate Osteosynthesis (Group M) and Conventional Plate Osteosynthesis (Group C) Groups

Operative Technique

Each patient was lying in a beach chair position at a 45° angle. All surgeries were performed under general anesthesia by a single surgeon (J.Y.K.).

Minimally Invasive Plate Osteosynthesis

First, the authors intended to use a long, 7- to 8-hole clavicular plate in MIPO for the following reasons: (1) the fracture might not be reduced accurately and an increase in length would be possible after reduction, and (2) the working length of the clavicular fracture should be obtained using MIPO with at least 3 screws on each side of the fracture for the rigid fixation. The surgical technique for MIPO is shown in Figure 2. Under fluoroscopic C-arm guidance, incision sites at approximately 2 hole lengths of the clavicular plate (7- to 8-hole lengths) were marked at the anterosuperior aspect of the clavicle (the medial and lateral ends of the plate). After skin incisions were made, a small Cobb elevator was introduced along the clavicle to create a subplatysma tunnel for the plate. Through a medial incision, an oblique hole was made at the anterior surface of the medial fragment using a 2.5-mm drill bit. A 2.0-mm diameter flexible titanium nail (Nancy nail; C&S, Pocheon, Korea) was then placed in the medial fracture fragment to attempt reduction. The authors attempted to move the ipsilateral shoulder upward and posteriorly for successful reduction. If acceptable reduction was achieved temporarily, a prebent 3.5-mm locking compression clavicular plate (Synthes or Tradimedics) was applied in the superior aspect of the clavicle through 2 mini-incisions. Usually, the clavicular plate was inferiorly prebent at the lateral, second-hole location. Temporary reduction with some gap between 2 main fragments was acceptable if the gap length or interval was less than 5 mm.

The surgical technique for minimally invasive plate osteosynthesis. Before incision, the plate was placed on the skin and positioned in the center of the fracture. Medial and lateral incision sites with 2 holes were marked (A). A flexible titanium nail with a diameter of 2.0 mm was prepared, introduced into the medial fracture fragments, and advanced to the lateral fragment for reduction (B, C). Two small skin incisions were made at the medial and lateral sides of the clavicle after the operation (D).

Figure 2:

The surgical technique for minimally invasive plate osteosynthesis. Before incision, the plate was placed on the skin and positioned in the center of the fracture. Medial and lateral incision sites with 2 holes were marked (A). A flexible titanium nail with a diameter of 2.0 mm was prepared, introduced into the medial fracture fragments, and advanced to the lateral fragment for reduction (B, C). Two small skin incisions were made at the medial and lateral sides of the clavicle after the operation (D).

Conventional Plate Osteosynthesis

The fracture site was identified using intraoperative plain radiography before skin incision. An anterior transverse incision was made along the clavicle over the center of the fracture site and extended until the whole fracture site was exposed, allowing application of the plate. During surgery, the authors were careful not to damage the supraclavicular nerve branches. After identifying the position of the fracture fragments, fractures were anatomically reduced as much as possible. For comminuted fractures, inter-fragmentary lag screws (2.0 and 3.5 mm in diameter) were used. However, the authors did not perform any adjuvant treatment to improve the fracture healing, such as bone grafting and hormonal treatment, during or after the surgery. In all cases, a locking compression plate (3.5-mm locking compression superior clavicle plates; Synthes or Tradimedics) was placed on the superior surface of the clavicle. To obtain maximum fixation strength, 3 screws were used in each of the proximal and distal fragments, regardless of the number of interfragmentary screws used.

Postoperative Protocols

For postoperative management, the authors recommended that patients wear an arm sling for 2 weeks. Light daily activities and passive stretching exercise were allowed immediately postoperatively. However, weight-bearing and weight-lifting activities were prohibited until 12 weeks postoperatively. These protocols were applied equally to the 2 groups.

Clinical Evaluation

The Constant score, visual analog scale (VAS) satisfaction score, operative time, total scar length, and incidence of any complications, including hypoesthesia, were evaluated. The Constant score uses a 100-point scale that assesses pain, activities of daily living, strength, and range of motion. The higher the score, the higher the quality of function. The satisfaction score was evaluated by asking, “How satisfied are you with the results of the operation? Zero means you are completely dissatisfied with the result, and 10 means you are completely satisfied with the results. Please rate from 0 to 10.”18 The VAS satisfaction and Constant scores were evaluated at least 1 year postoperatively. Hypoesthesia was evaluated at 6 weeks postoperatively.

The authors checked the light touch sensation over the clavicle and anterior chest of the injured shoulder and compared it with that of the contralateral side to determine the presence of hypoesthesia. The total scar length was measured at the final follow-up. In addition, the operative time for each group was evaluated immediately postoperatively. It was calculated from the start of the skin incision to skin closure.

Radiological Evaluation

Bone union was determined using a series of plain clavicular radiographs (anteroposterior, cephalic tilting, and caudal tilting) that revealed the presence of gap filling or callus formation between fragments. In addition, the authors evaluated the fracture gap interval by measuring the shortest vertical distance between adjacent fracture fragments (Figure 3). To evaluate the degree of comminution, the number of fracture fragments was counted.

The fracture gap interval (red line) was measured as the shortest vertical distance between adjacent fracture fragments.

Figure 3:

The fracture gap interval (red line) was measured as the shortest vertical distance between adjacent fracture fragments.

Follow-up

For the radiological evaluation, patients had routine follow-up at 2, 6, and 12 weeks postoperatively and then every 6 weeks until bone union was observed. A functional evaluation was performed at each follow-up visit. The minimum duration of follow-up was 1 year. The mean duration of follow-up was 13.33±1.72 months in group M and 13.73±1.79 months in group C.

Statistical Analysis

All statistical analyses were performed using SPSS version 18.0 software (SPSS Inc, Chicago, Illinois). P<.05 was considered statistically significant. Continuous variables were evaluated using the Mann–Whitney U test, whereas categorical variables were compared using the chi-square or Fisher's exact test.

Results

On clinical evaluation, although the Constant and VAS satisfaction scores were higher in group M than in group C, the differences were not significant (Constant score: 88.46±10.52 vs 81.27±8.36, P=.054; VAS satisfaction score: 8.54±0.97 vs 7.86±0.86, P=.065). However, operative time (52.33±13.87 vs 110.33 ± 25.39 minutes, P<.001) and scar length (64.95±3.19 vs 99.39±15.98 mm, P<.001) were significantly shorter in group M than in group C, respectively. Three patients in group C and 1 patient in group M reported paresthesia around the incision site (P=.249). Complications such as nonunion, implant failure, refracture, and infection did not occur in either group (Table 2).

Comparison of Clinical and Radiological Outcomes Between the Minimally Invasive Plate Osteosynthesis (Group M) and the Conventional Plate Osteosynthesis (Group C) Groups

Table 2:

Comparison of Clinical and Radiological Outcomes Between the Minimally Invasive Plate Osteosynthesis (Group M) and the Conventional Plate Osteosynthesis (Group C) Groups

Regarding radiological evaluation, no significant difference was noted in the time to bone union (group M: 21.20±12.10 weeks; group C: 17.13±6.53 weeks, P=.262). In group M, the time to bone union was significantly correlated with gap interval (kappa=0.692, P=.004) and the number of fracture fragments (kappa=0.722, P=.002). The biggest gap interval in group M was 4.8 mm, and bone union between fracture fragments was observed at 9 months postoperatively (Figure 4). The most comminuted fractures (with 4 fracture fragments) in group M showed the most delayed bone union (occurring at 12 months postoperatively) (Figure 5). There was no correlation between Constant score and time to bone union (P=.665 in group C and P=.926 in group M) or between scar length and VAS satisfaction score (P=.898).

A midshaft clavicle fracture with AO/OTA classification type A (A) was surgically treated with the minimally invasive plate osteosynthesis technique. The gap interval was measured at 4.8 mm (B). Nine months postoperatively, bone union was achieved (C).

Figure 4:

A midshaft clavicle fracture with AO/OTA classification type A (A) was surgically treated with the minimally invasive plate osteosynthesis technique. The gap interval was measured at 4.8 mm (B). Nine months postoperatively, bone union was achieved (C).

A midshaft clavicle fracture with 4 fracture fragments (A) was surgically treated with the minimally invasive plate osteosynthesis technique (B). Bone union was achieved 12 months postoperatively (C).

Figure 5:

A midshaft clavicle fracture with 4 fracture fragments (A) was surgically treated with the minimally invasive plate osteosynthesis technique (B). Bone union was achieved 12 months postoperatively (C).

Discussion

There was no difference in functional outcomes between MIPO and conventional plate osteosynthesis for midshaft clavicle fractures.5,7,9,10,15,16,18,19 Although some gap may have been present after reduction, there was no significant difference in the time to bone union between MIPO and conventional plate osteosynthesis. Notable associations were found between the gap interval as well as the number of fracture fragments and time to bone union in the MIPO group.

Before completing this study, the authors hypothesized that MIPO might be superior to conventional plate osteosynthesis regarding the incidence of hypoesthesia, as reported previously.5 However, there was no significant difference in the incidence of hypoesthesia between the 2 groups. Only 3 of 15 patients showed hypoesthesia in the conventional plate osteosynthesis group, although this was higher than the incidence in the MIPO group (1 of 15 patients). This might be due to the careful dissection during surgery to avoid damaging the supraclavicular nerve branches and the wide variations in nerve branch location. The authors' other hypothesis was that the cosmetic superiority of MIPO might influence the patients' satisfaction after the surgery at the final follow-up. However, the results of this study did not support this hypothesis, as the authors did not observe any superiority of the MIPO group over the conventional plate osteosynthesis group regarding VAS satisfaction score. Multiple factors could influence patient satisfaction, such as range of motion, pain, hypoesthesia, radiological outcome, scars, and other medical services provided to patients. Therefore, no difference regarding satisfaction might be observed at the end of follow-up. At times, reduction could be difficult to achieve during MIPO, especially for comminuted fractures of AO/OTA classification type C. However, once temporary reduction was achieved with an acceptable gap (<5 mm), the next procedure could be easily completed in 20 minutes. The authors observed a definite superiority of MIPO over conventional plate osteosynthesis regarding operative time. The reduced duration of surgery might in turn reduce the surgical burden for surgeons. The mean operative time in the current study was 52 minutes, which was much shorter than the 77 minutes in a study by Sohn et al10 and the 60 minutes in a study by Jiang and Qu.5 This difference might indicate that the surgical technique used in the current study is easier and more replicable than the others. However, in this study, 2 cases in the MIPO group completely failed to achieve reduction. This failure might have been caused by learning curves (second and fourth cases), inappropriate techniques, or limitations of the flexible nailing surgery for temporary reduction of posteriorly comminuted mid-shaft clavicle fractures.

Interestingly, the authors found strong correlations between both the fracture gap intervals and the number of fracture fragments and the time to bone union in group M; however, no correlation was observed in group C. As all fracture fragments were reduced without gap or with minimal gap, if any, in conventional plate fixation, this relationship seems to be meaningful only in the MIPO group. Further, MIPO seems to involve more time in bone union by gap healing with callus formation. Nevertheless, the benefits of MIPO, such as less soft tissue injury, cosmetic superiority, and reduced operative time, would offset the small increase in bone union time.

This is the first study comparing MIPO with conventional plate osteosynthesis in some gap interval between fracture fragments and analyzing the effect of gap interval and number of fragments on bone union in MIPO. However, this study had several limitations. First, the authors used flexible titanium nails for the reduction, which might have disturbed the endosteal blood supply system and caused some degree of rotational malalignment. Second, computed tomography scans would be better than radiographs for determining bony unions. Third, the distributions of fracture types were not identical, and the number of AO/OTA type C fractures was too small. Further study with a larger sample may be necessary to resolve this discrepancy to some extent and to draw any strong conclusions from the current study. Finally, the study would have been more informative if the authors had included the conservative treatment group for comparison.

Conclusion

Minimally invasive plate osteosynthesis showed some superiority over conventional plate fixation for midshaft clavicle fractures, having a shorter operative time and scar length. Minimally invasive plate osteosynthesis provides reasonable results that are comparable to those of conventional plate fixation. The time to bone union was influenced by the reduction status and the number of fracture fragments in the MIPO group.

References

  1. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012; 94(8):675–684. doi:10.2106/JBJS.J.01364 [CrossRef]
  2. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MDEvidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures. On behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005; 19(7):504–507. doi:10.1097/01.bot.0000172287.44278.ef [CrossRef]
  3. Donnelly TD, Macfarlane RJ, Nagy MT, Ralte P, Waseem M. Fractures of the clavicle: an overview. Open Orthop J. 2013; 7:329–333. doi:10.2174/1874325001307010329 [CrossRef]
  4. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012; 132(5):617–625. doi:10.1007/s00402-011-1456-5 [CrossRef]
  5. Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res. 2012; 98(6):666–671. doi:10.1016/j.otsr.2012.02.011 [CrossRef]
  6. Der Tavitian J, Davison JN, Dias JJ. Clavicular fracture non-union surgical outcome and complications. Injury. 2002; 33(2):135–143. doi:10.1016/S0020-1383(01)00069-9 [CrossRef]
  7. Sohn HS, Kim BY, Shin SJ. A surgical technique for minimally invasive plate osteosynthesis of clavicular midshaft fractures. J Orthop Trauma. 2013; 27(4):e92–e96. doi:10.1097/BOT.0b013e31826579c7 [CrossRef]
  8. Böstman O, Manninen M, Pihlajamäki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997; 43(5):778–783. doi:10.1097/00005373-199711000-00008 [CrossRef]
  9. Lee HJ, Oh CW, Oh JK, et al. Percutaneous plating for comminuted midshaft fractures of the clavicle: a surgical technique to aid the reduction with nail assistance. Injury. 2013; 44(4):465–470. doi:10.1016/j.injury.2012.09.030 [CrossRef]
  10. Sohn HS, Kim WJ, Shon MS. Comparison between open plating versus minimally invasive plate osteosynthesis for acute displaced clavicular shaft fractures. Injury. 2015; 46(8):1577–1584. doi:10.1016/j.injury.2015.05.038 [CrossRef]
  11. Wang K, Dowrick A, Choi J, Rahim R, Edwards E. Post-operative numbness and patient satisfaction following plate fixation of clavicular fractures. Injury. 2010; 41(10):1002–1005. doi:10.1016/j.injury.2010.02.028 [CrossRef]
  12. Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury. 2001; 32(suppl 3):SC14–SC23. doi:10.1016/S0020-1383(01)00180-2 [CrossRef]
  13. Perren SM. Evolution of the internal fixation of long bone fractures: the scientific basis of biological internal fixation. Choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002; 84(8):1093–1110. doi:10.1302/0301-620X.84B8.13752 [CrossRef]
  14. Röderer G, Erhardt J, Graf M, Kinzl L, Gebhard F. Clinical results for minimally invasive locked plating of proximal humerus fractures. J Orthop Trauma. 2010; 24(7):400–406. doi:10.1097/BOT.0b013e3181ccafb3 [CrossRef]
  15. Jung GH, Park CM, Kim JD. Biologic fixation through bridge plating for comminuted shaft fracture of the clavicle: technical aspects and prospective clinical experience with a minimum of 12-month follow-up. Clin Orthop Surg. 2013; 5(4):327–333. doi:10.4055/cios.2013.5.4.327 [CrossRef]
  16. Sohn HS, Shon MS, Lee KH, Song SJ. Clinical comparison of two different plating methods in minimally invasive plate osteosynthesis for clavicular midshaft fractures: a randomized controlled trial. Injury. 2015; 46(11):2230–2238. doi:10.1016/j.injury.2015.08.018 [CrossRef]
  17. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg. 2010; 19(6):783–789. doi:10.1016/j.jse.2010.05.002 [CrossRef]
  18. Tieyi Y, Shuyi L, Yan Z, Guohua H, Jin S, Rui J. Minimally invasive plating for fresh displaced midshaft fractures of the clavicle. Orthopedics. 2014; 37(10):679–683. doi:10.3928/01477447-20140924-05 [CrossRef]
  19. Zhang Y, Xu J, Zhang C, Sun Y. Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating. J Shoulder Elbow Surg. 2016; 25(1):e7–e12. doi:10.1016/j.jse.2015.06.024 [CrossRef]

Demographics of the Minimally Invasive Plate Osteosynthesis (Group M) and Conventional Plate Osteosynthesis (Group C) Groups

CharacteristicGroup M (n=15)Group C (n=15)P
Age, mean±SD, y38.13±17.1038.15±21.18.970
Sex, male:female, No.10:511:4.690
Follow-up duration, mean±SD, mo13.33±1.7213.73±1.79.501
Injury mechanism, No..676
  Motor vehicle accident43
  Slip109
  Fall11
  Direct blow02
AO/OTA classification,aNo..648
  Type A911
  Type B42
  Type C22
Fracture site gap, mean±SD, mm1.20±1.370.70±1.07.275

Comparison of Clinical and Radiological Outcomes Between the Minimally Invasive Plate Osteosynthesis (Group M) and the Conventional Plate Osteosynthesis (Group C) Groups

OutcomeGroup M (n=15)Group C (n=15)P
Operative time, mean±SD, min52.33±13.87110.33±25.39<.001
Time to bone union, mean±SD, wk21.20±12.1017.13±6.53.262
Scar length, mean±SD, mm64.95±3.1999.39±15.98<.001
Final Constant score, mean±SD88.46±10.5281.27±8.36.054
Visual analog scale satisfaction score, mean±SD8.54±0.977.86±0.86.065
Complication, No.
  Nonunion00
  Metal failure or refracture00
  Infection00
  Hypoesthesia13.249
Authors

The authors are from the Department of Orthopedic Surgery (JYK), Myongji Hospital, Hanyang University College of Medicine, Goyang-si; the Department of Orthopedic Surgery (BCY), Myongji Hospital, Goyang-si; the Department of Orthopaedic Surgery (JPY), Kyungpook National University, School of Medicine, Daegu; and the Department of Orthopaedic Surgery (SJK, SWC), Konkuk University School of Medicine, Seoul, Korea.

The authors have no relevant financial relationships to disclose.

This study was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant HI15C1856).

Correspondence should be addressed to: Seok Won Chung, MD, PhD, Department of Orthopaedic Surgery, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul 143-729, Korea ( smilecsw@gmail.com).

Received: December 11, 2017
Accepted: April 03, 2018
Posted Online: July 16, 2018

10.3928/01477447-20180711-05

Sign up to receive

Journal E-contents