Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture

<b><i>Background:</i></b> Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. <b><i>Methods:</i></b> A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant-Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. <b><i>Results:</i></b> The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; <i>p</i> < 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; <i>p</i> < 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; <i>p</i> < 0.001). Both groups had similarly excellent Constant-Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; <i>p</i> = 0.036). Neither group experienced any infection, implant failure, or nonunion. <b><i>Conclusions:</i></b> Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.