Clinical outcomes and complication rates of minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in midshaft clavicular fractures: a comparative study.

BACKGROUND: Conventional open reduction and internal fixation (ORIF) remains the standard approach for midshaft clavicle fractures, yet its traumatic nature has driven the need for minimally invasive techniques. Locking minimally invasive plate osteosynthesis (MIPO) demonstrates clinical potential through biomechanical superiority and tissue-preserving characteristics.

OBJECTIVE: To compare the clinical efficacy and safety of MIPO versus ORIF for midshaft clavicular fractures.

METHODS: A retrospective cohort study included 203 patients (MIPO group:101 cases; ORIF group:102 cases) treated between 2022 and 2024. Baseline characteristics, functional outcomes (DASH and Constant-Murley scores), and complications were analyzed using Mann-Whitney U and chi-square tests.

RESULTS: No baseline differences were observed (P > 0.05). Functional outcomes were equivalent between groups (DASH score: P = 0.906; Constant-murley score: P = 0.646). The overall complication rate was significantly lower in the MIPO group than in the ORIF group (7.92% vs. 36.27%, P < 0.001), particularly in nonunion (0% vs. 5.88%, P = 0.039) and sensory disturbance (6.93% vs. 27.45%, P < 0.001). This advantage is also evident in the subgroup of patients with AO type 2 C fractures, where MIPO similarly demonstrates a significantly lower incidence of these two complications.

CONCLUSION: MIPO achieves comparable functional recovery to ORIF while reducing postoperative complications, supporting its prioritization in midshaft clavicular fracture management.