Percutaneous plating for comminuted midshaft fractures of the clavicle: A surgical technique to aid the reduction with nail assistance

Introduction: Due to the complex anatomy of the clavicle, percutaneous plating with indirect reduction for comminuted midshaft fracture of the clavicle is challenging. The aim of this series was to report on a novel technique of nail-assisted percutaneous plating and to evaluate the radiographic and clinical outcomes in comminuted midshaft fractures of the clavicle. Materials and methods: Between 2009 and 2010, with nail assistance for the reduction and its maintenance, percutaneous plating was performed in 14 patients with comminuted midshaft fracture of the clavicle. The mean follow-up period was 17.6 months (range, 15-31 months). A retrospective review of the clinical and radiologic results for these patients was conducted. Results: All fractures healed within a mean period of 15.6 weeks (range, 11-18 weeks) without loss of reduction. Regarding complications, there was no occurrence of implant failure or infection. All patients showed excellent shoulder function, with a mean Constant shoulder score of 99, and a mean Disabilities of the Arm, Shoulder and Hand (DASH) score of 4.2 (range, 0-22) at the latest follow-up. No significant difference in mean proportional length was observed between injured and uninjured clavicles, with a mean of 0.4% (range, -1.5% to 2.4%). Conclusions: Minimally invasive percutaneous plating for comminuted midshaft fractures of the clavicle, combining the advantages of elastic intramedullary nailing and percutaneous plating, may be a good option.