Clavicular fractures account for 2.6% of all adult fractures, with as many as 80% occurring in the midshaft region. Since the early 1990s, the conservative management protocol proposed by Neer has long been regarded as the first-line treatment for clavicular fractures. Nevertheless, multiple studies have verified that non-surgical treatment frequently fails to maintain reduction in significantly displaced or comminuted midshaft clavicular fractures, resulting in progressive displacement and aggravated shortening, which markedly elevates the risks of symptomatic malunion and nonunion. Furthermore, reports have indicated that patients managed without surgery suffer from reduced shoulder strength. Accordingly, surgical intervention has gained growing preference for patients with clavicular fractures in recent years, among which open reduction and internal fixation (ORIF) with plate fixation is widely adopted.
For such complex fractures, The doctor focused on a fixation technique augmented with mini-plates. These plates function similarly to lag screws yet offer simpler application. Intraoperative observations also demonstrated robust stability, and favorable clinical outcomes have been achieved with their use in comminuted patellar fractures. Drawing on research confirming that dual-plate fixation delivers sufficient mechanical stability, The doctor utilized orthopedic mini plate to secure small fracture fragments to the main bone segment, successfully converting complex fracture patterns into simpler configurations. Subsequent reduction of the fracture surfaces was facilitated, followed by placement of a superior locking compression plate (LCP). To minimize periosteal injury, only minimally invasive incisions were made to expose screw insertion sites, achieving fixation consistent with the principles of minimally invasive plate osteosynthesis (MIPO).
Clinical Case
Preoperative assessment of fracture morphology was performed using X ray films and 3D reconstructed CT scans. A 22 year old male patient was diagnosed with a right midshaft clavicular fracture incurred during sports activities. Anteroposterior clavicular radiograph (a) and apical oblique radiograph (b) verified that the fracture belonged to AO/OTA classification type 15.2C (comminuted multifragmentary fracture). Three-dimensional reconstructed CT images of the patient demonstrated a stereoscopic visualization of the spatial fracture configuration, providing intuitive anatomical evidence for preoperative planning.
The patient was placed in the beach-chair position under general anesthesia, with the head and neck tilted away from the operative side. After routine disinfection and sterile draping, the entire contour of the clavicle and fracture site were marked with a surgical marker under fluoroscopic guidance by a C-arm. A transverse incision approximately 5 cm in length (matching the length of the fracture zone) was made along the clavicular fracture line. One Titanium Clavicle Plate (2.0 mm compact Orthopedic Clavicle Plate) was applied to assist fracture reduction.Clavicle plate were used to bridge and fix wedge-shaped or comminuted bone fragments to the main fracture segments. After converting the complex fracture into a mechanically simple configuration, fixation with a superior medical locking plate was performed. A clavicular LCP (3.5 mm superior clavicular LCP system) was placed on the superior cortical surface of the clavicle and implanted via minimally invasive plate osteosynthesis (MIPO) technique.The patient wore a sling for the first 7 postoperative days to relieve discomfort, followed by initiation of range-of-motion exercises. At 8 weeks postoperatively, muscle-strengthening training was commenced once radiographs confirmed bone union and clinical assessment revealed mild pain. X-ray examinations (anteroposterior clavicular view and apical oblique clavicular view) were obtained immediately after surgery and at every outpatient follow-up visit.
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