Complications and clinical outcomes with minimally invasive plate osteosynthesis (MIPO) technique for midshaft clavicle fractures: a systematic review and meta-analysis

Abstract

Background: Clavicle fractures are among the most common upper limb fractures in adults, with the midshaft region being the most frequently affected site. Minimally invasive plate osteosynthesis (MIPO) has emerged as an alternative to the traditional open reduction and internal fixation (ORIF) technique, offering potential advantages. The purpose of this study was to conduct a systematic review to explore the results of this technique in the existing literature, with emphasis on the occurrence of surgical complications and functional outcomes and also to provide a comprehensive comparison of MIPO and ORIF in the management of midshaft clavicle fractures.

Methods: We conducted a systematic review to evaluate the complication incidence and clinical outcomes of MIPO for midshaft clavicle fractures. We searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, the Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews databases without language or date restrictions. Studies focusing on midshaft clavicle fractures treated with MIPO were included, while other clavicle fractures and nonclinical studies were excluded. The risk of bias was assessed using the Methodological Index for Nonrandomized Studies criteria and the Risk of Bias Tool 2 Cochrane tool. Data synthesis included qualitative analysis, and if applicable, quantitative analysis and meta-analysis. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured reporting quality.

Results: A total of 107 studies were initially identified, after applying inclusion and exclusion criteria, 22 studies were included for data extraction. These studies involved the evaluation of 714 clavicles treated with the MIPO technique. Of the 714 MIPO cases, 11 cases of implant failure, 5 nonunions, 2 infections, and 28 cases with neurological impairment were observed. Quantitative analysis comparing MIPO with ORIF revealed that MIPO had significantly shorter surgery time (mean difference -12.95, 95% confidence interval [-25.27 to -0.63], P = .04) and lower occurrence of numbness (odds ratio 0.29, 95% CI [0.15-0.56], P = .0002) compared to ORIF. Time to bone union, functional outcomes, and other complications were similar between MIPO and ORIF at the final follow-up. An overall moderate risk of bias was found across the studies.

Conclusion: The MIPO technique yields good and comparable results to ORIF for midshaft clavicle fractures. Additionally, the MIPO technique may offer advantages such as reduced surgical time and lower chances of neurological impairment.

Keywords: Clinical outcomes; Comparative analysis; MIPO; Midshaft clavicle fractures; Minimally invasive plate osteosynthesis; Surgical treatment; Systematic review.

Figure 1

PRISMA flow diagram with study selection. PRISMA, preferred reporting items for systematic reviews and meta-analyses.

Figure 2

(A and B): Risk of bias assessment by the RoB2 tool. RoB2, risk of bias 2.

Figure 3

(A and B): Risk of bias assessment by the ROBINS-I tool. ROBINS-I, risk of bias in nonrandomized studies of interventions.

Figure 4

Surgical time compared between MIPO and ORIF groups.

Figure 5

Time to union compared between MIPO and ORIF groups. MIPO, minimally invasive plate osteosynthesis; ORIF, open reduction and internal fixation; CI, confidence interval.

Figure 6

(A): Paresthesia compared between MIPO and ORIF groups. (B): Infection compared between MIPO and ORIF groups. (C): Nonunion compared between MIPO and ORIF groups. (D): Implant failure compared between MIPO and ORIF groups. MIPO, minimally invasive plate osteosynthesis; ORIF, open reduction and internal fixation; CI, confidence interval.

Figure 7

(A): q-DASH compared between MIPO and ORIF group. (B): DASH compared between MIPO and ORIF groups. (C): Constant compared between MIPO and ORIF groups. q-DASH, quick disabilities of the arm shoulder and hand score; DASH, disabilities of the arm shoulder and hand score; MIPO, minimally invasive plate osteosynthesis; ORIF, open reduction and internal fixation; CI, confidence interval.

Figure 8

(A): Sensitivity analysis including the study by Sohn et al in the comparison of paresthesia between MIPO and ORIF groups. (B): Sensitivity analysis including the study by Sohn et al in the comparison of infection between MIPO and ORIF groups. (C): Sensitivity analysis including the study by Sohn et al in the comparison of bone nonunion between MIPO and ORIF groups. (D): Sensitivity analysis including the study by Sohn et al in the comparison of implant failure between MIPO and ORIF groups. MIPO, minimally invasive plate osteosynthesis; ORIF, open reduction and internal fixation; CI, confidence interval.