ABSTRACT
Objective To compare the outcomes of percutaneous Kirschner wire assisted reduction with minimally invasive plate osteosynthesis and open reduction with locking plate in treatment of Robinson type 2B midshaft clavicular fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 96 patients with Robinson type 2B midshaft clavicular fracture from June 2009 to October 2016.There were 70 males and 26 females with an average age of 34.5 years.The patients were divided into two groups according to the different surgical methods:49 patients were treated with percutaneous Kirschner wire assisted reduction and minimally invasive locking plate osteosynthesis (minimally invasive group);47 patients were treated with open reduction with locking plate internal fixation (open plating group).According to the Robinson fracture typing,there were 28 patients with type 2B1 and 21 with type 2B2 in the minimally invasive group;there were 23 patients with type 2B1 and 24 with type 2B2 in open plating group.The length of incision,operation time,visual analog scale (VAS) 2 days after surgery,length of hospital stay,time of fracture healing,Constant score results of postoperative 6 months,1 year,and at the last follow-up,feedbacks on incision and functional satisfaction,and complications were compared between the two groups.Results The average follow-up was (19.6 ± 5.5)months in minimally invasive group and (20.3 ± 6.2)months in open plating group.The incision lengths of the minimally invasive group and the open plating group were (4.8 ±0.7)cm and (8.3 ± 1.6) cm,respectively.The minimally invasive group had significantly longer operation time [(75.5 ±21.6)minutes] compared with open plating group [(60.2 ± 19.1)minutes] (P ＜0.0l).In the minimally invasive group and open plating group,the VAS 2 days after surgery was (2.9 ± 1.5) points and (3.9 ± 1.7) points;the hospitalization time was (7.1 ± 2.6) days and (9.5 ± 2.9) days;the fracture healing time was (11.7 ± 2.2) weeks and (13.4 ± 2.9) weeks;patients' satisfaction with the appearance of the incision was 84％ and 60％,respectively.There were no significant differences in the Constant score and functional satisfaction between the two groups at postoperative 6 months,l year,and the last follow-up (P ＞ 0.05).The incidence of postoperative incisional hypertrophic scar was 8％ and 30％,and the incidence of local skin numbness or sensory loss was 10％ and 32％ in minimally invasive group and open plating group,respectively (P ＜ 0.0l).No significant differences in nonunion,internal fixation failure,incision infection,subcutaneous prominent plate or revision rate were found between the two groups (P ＞ 0.05).Conclusion Percutaneous Kirschner wire assisted reduction with minimally invasive locking plate and open reduction with locking plate internal fixation can both achieve good clinical outcomes in the treatment of Robinson 2B midshaft clavicular fracture;but the former shows more advantages in terms of incision length,incision appearance,operation time,pain 2 days after surgery,fracture healing time,and local skin sensory disturbances.