Clavicular fracture, MIPO_vs_ORIF_Presentation.pptx

Clavicular fracture, MIPO_vs_ORIF

1. Minimally invasive plate osteosynthesis (MIPO) with mini-open technique versus open reduction and internal fixation (ORIF) in the treatment of displaced midclavicular fracture : a retrospective study Dr. Satish Kumar Panigrahy Junior resident Dept of orthopaedics scbmch

2. Authors & Source Shakya et al., Journal of Orthopaedics and Traumatology (2025)

3. Abstract Overview Retrospective study comparing MIPO with mini-open technique vs conventional ORIF for displaced midshaft clavicular fractures.

4. Objective To evaluate surgical outcomes, supraclavicular nerve (SCN) injury, and patient satisfaction between MIPO and ORIF.

5. Introduction Clavicle fractures account for 3–5% of all fractures, with 80% at the midshaft. Shift from conservative to surgical treatment for displaced fractures.

6. Background ORIF is the gold standard but associated with nerve injury and soft tissue damage. MIPO aims to minimize incision, preserve SCN, and improve outcomes.

7. Study Design Retrospective observational study, 45 patients (Dec 2020–Jun 2022), approved by Ethics Committee of West China Hospital.

8. Patient Demographics MIPO: 20 patients (14M/6F, avg age 38.1) ORIF: 25 patients (17M/8F, avg age 36.9) Mechanisms: accidents, sports, falls, workplace injuries.

9. Inclusion & Exclusion Included: Age ≥18, displaced midclavicle fractures >2cm shortening. Excluded: open fractures, nerve/artery injury, short follow-up.

10. Statistical Methods Mann–Whitney U and Fisher’s exact tests; p<0.05 considered significant. Analyzed using GraphPad Prism 9.5.1.

11. MIPO Technique Mini 1.5–2 cm incisions, preservation of SCN, tunnel creation for plate insertion, guided by fluoroscopy.

12. ORIF Technique 8–10 cm incision, direct exposure and plating of fracture with protection of visible SCN branches.

13. Postoperative Care Antibiotics 24h, analgesia, arm sling 2 weeks, gradual mobilization from week 6, DASH and CMS scoring for function.

14. Key Operative Findings MIPO shorter incision (4.1cm vs 7.5cm), less blood loss (27 vs 58mL), higher fluoroscopy use, similar operative time.

15. Complications ORIF had higher numbness (36% vs 5%), infections (12% vs 0%), and thick scars (40% vs 5%).

16. Pain & Recovery MIPO had lower VAS pain scores on days 1 and 3; both groups achieved similar union times and DASH/CMS functional outcomes.

17. Functional Outcomes DASH: ~12 in both groups. CMS: MIPO 92.4 vs ORIF 89.8 (NS).

18. Patient Satisfaction MIPO group significantly more satisfied with scar (4.25 vs 2.08) and overall surgery satisfaction (p<0.001).

19. Discussion – Overview MIPO reduces SCN injury, incision size, and scarring; offers better cosmetic and satisfaction outcomes.

20. Discussion – SCN Injury MIPO minimizes supraclavicular nerve damage by avoiding the high-risk central zone between 2–3 cm of the clavicle ends.

21. Discussion – Healing & Recovery Both groups showed good union rates; MIPO facilitates biological fixation and preserves periosteal blood supply.

22. Limitations Retrospective design, limited sample size, subjective numbness reporting, and lack of nerve conduction studies.

23. Conclusion MIPO is a safer and more effective option for displaced midclavicular fractures, improving cosmetic and sensory outcomes.

24. Clinical Implications Recommended for modern orthopedic surgical practice for better patient satisfaction and fewer complications.

25. Acknowledgements & References Thanks to surgeons Chen Jia Lei, Duan Xin, Zhang Qing. Key references: Michelitsch et al. 2023, You et al. 2018, Nathe et al. 2011.