COMPARISON OF MINIMALLY INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS (MIPPO) TECHNIQUE AND CONVENTIONAL OPEN REDUCTION WITH LOCKING COMPRESSION PLATE (LCP) FOR THE TREATMENT OF CLAVICLE MIDSHAFT FRACTURES IN ADULTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL (R

Abstract

Background: The present study investigated operative treatment of clavicle midshaft fractures in adults by comparing minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and conventional open reduction using locking compression plate(LCP) in a randomized, controlled, clinical trial with a minimum of 1-year follow-up.

Materials and methods: Between June 2015 and May 2018, 40 cases of open reduction and internal plate fixation were performed at Department of Orthopaedics, Gandaki Medical College, Pokhra, Nepal; for clavicle midshaft fractures. The inclusion criteria for the operation included complete displacement, severe comminution and marked shortening of more than 2cm of the clavicle. MIPPO and conventional open reduction surgery procedures with LCP were used in 20 and 20 cases, respectively.

Results: The mean time to union was 14 weeks in the open reduction group compared to 12 weeks in MIPPO group (P > 0.05). The MIPPO group had no significantly superior Constant shoulder scores or DASH scores at all time-points (P > 0.05). However, the open reduction group showed associated complications as dysesthesia in the area of the incision and directly below which was reported in 6 cases, hypertrophic scarring reported in 3 cases, painful shoulder in 2 cases and a limitation of shoulder motion in one case (P > 0.05). The complications in the MIPPO group were dysesthesia in two cases, no hypertrophic scarring, no painful shoulder, and no limitation of shoulder motion were noted (P < 0.05). Patients in this operative group were more satisfied with cosmetic appearance and overall outcome than those in the conventional open reduction group.

Conclusions: The stable fixation can be achieved through operative treatment with a locking compression plate for clavicle shaft fractures. Particularly, MIPPO of displaced midshaft clavicular fractures resulted in a lower rate of dysesthesia, hypertrophic scarring, and a better cosmetic than conventional open reduction, although the functional outcomes (Constant and DASH) were no different between the two groups. Overall satisfaction was higher in the MIPPO group than conventional open reduction group. MIPPO group was aesthetically more acceptable compared to the open reduction group.