Abstract
Objective
To evaluate the clinical efficacy and advantages of Minimally Invasive Plate Osteosynthesis (MIPO) for the treatment of displaced midshaft clavicle fractures (DMCFs).
Methods
A retrospective case–control study was conducted involving 79 patients with DMCFs treated at our institution between January 2021 and December 2024. Patients were divided into two groups based on the surgical technique: MIPO (n = 32) and Open Reduction and Internal Fixation (ORIF) (n = 47). Key parameters—including operative time, intraoperative blood loss, incision length, complications, patient satisfaction, and functional recovery outcomes—were compared.
Results
Compared to the ORIF group, the MIPO group demonstrated significantly shorter operative time (54.22 ± 5.14 min vs. 61.15 ± 6.01 min, p < 0.001), reduced intraoperative blood loss (45.44 ± 4.27 mL vs. 52.81 ± 6.60 mL, p < 0.001), and shorter incision length (6.42 ± 0.48 cm vs. 12.25 ± 1.60 cm, p < 0.001). Postoperative supraclavicular nerve injury was less frequent in the MIPO group (12.5% vs. 38.3%, p < 0.001) and patient satisfaction was higher (90.6% vs. 72.3%, p = 0.021). No significant differences were observed in functional outcomes, as assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores.
Conclusion
While both surgical techniques yielded comparable functional recovery, MIPO demonstrated distinct intraoperative and early postoperative advantages, including shorter incisions, less blood loss, fewer nerve-related complications, and higher patient satisfaction. These findings support the clinical utility and therapeutic efficacy of MIPO in the management of DMCFs.
Keywords: Displaced midshaft clavicle fractures, Minimally invasive plate osteosynthesis, Open reduction and internal fixation, Clinical outcomes
Introduction
Clavicle fractures are among the most common injuries encountered in trauma orthopedics, accounting for approximately 3–4% of all skeletal fractures. Displaced midshaft clavicle fractures (DMCFs) constitute the majority, representing 69–81% of all clavicle fractures [1, 2]. The clavicle plays a vital role in upper limb movement, thoracic stability, postural alignment, respiratory coordination, and the protection of critical neurovascular structures. In DMCFs, the distal fragment experiences anterior and downward displacement due to traction from the deltoid muscle, while the proximal fragment is displaced posterosuperiorly under the influence of the sternocleidomastoid muscle,resulting in fracture instability [1, 2]. Traditionally, conservative management has been the preferred approach. However, it is associated with a higher incidence of malunion and nonunion [3, 4]. In light of increasing expectations for optimal outcomes and faster recovery, surgical intervention has emerged as the preferred choice for both patients and clinicians [3–5].
Open reduction and internal fixation (ORIF) is a commonly employed surgical technique for the treatment of DMCFs, as it enables early fracture stabilization, facilitates prompt mobilization, and shortens the overall rehabilitation period [6, 7]. However, achieving such stable anatomical reduction typically requires a relatively long incision and extensive dissection of soft tissues and periosteum, which may result in iatrogenic injury to surrounding blood vessels and nerves, thereby increasing the risk of delayed union or nonunion. Consequently, there is growing interest in minimally invasive surgical alternatives that better preserve soft tissue integrity [8–11].
Minimally Invasive Plate Osteosynthesis (MIPO) is designed to minimize surgical trauma by maintaining the periosteal blood supply and adhering to the principles of biological osteosynthesis [12, 13]. In recent years, MIPO has gained popularity in the treatment of DMCFs and has demonstrated promising clinical outcomes [8–11]. Nevertheless, its adoption remains limited due to technical complexity, the requirement for specialized instruments, and insufficient awareness of its benefits among orthopedic surgeons.
This study aims to retrospectively compare the clinical outcomes of MIPO and ORIF in the treatment of DMCFs. Specifically, we evaluated operative parameters, complication rates, functional recovery, and patient satisfaction. In addition, we share our surgical experience with MIPO in the treatment of DMCFs, with the aim of providing valuable insights and expanding therapeutic options for clinical practice.
Methods
Study population
A retrospective analysis was conducted on patients who underwent surgical treatment for DMCFs at our orthopedic center between January 2021 and December 2024. Based on the surgical approach performed, patients were assigned to either the MIPO group or the ORIF group.
Since July 2022, MIPO has been adopted as the preferred surgical approach in our department due to increasing clinical evidence supporting its advantages, enhanced surgical expertise among the clinical team, and growing patient preference for minimally invasive procedures. Consequently, patients in the ORIF group were primarily treated between January 2021 and July 2022, whereas those in the MIPO group were treated between August 2022 and December 2024.
Inclusion criteria were as follows: aged between 18 and 65 years; unilateral clavicle fracture; closed fracture; and absence of neurovascular injury. Exclusion criteria included: fractures older than three weeks; pathological clavicle fractures; multiple traumatic injuries that could interfere with recovery (e.g., concurrent cranial injuries, shoulder joint injuries, or lower limb fractures requiring prolonged immobilization); and loss to follow-up (Fig. 1).
Fig. 1.
Illustrates the flowchart depicting the process of participant inclusion
Preoperative data
Medical history gathering
Comprehensive baseline data were collected for each patient, including age, sex, body mass index (BMI), mechanism of injury, fracture classification [14, 15], smoking history, alcohol consumption, and any history of hypertension or diabetes.
Preoperative preparation
Prior to surgery, all patients underwent three-dimensional computed tomography (CT) scans to rule out occult fractures and assist in surgical planning. Regional anesthesia was administered via a combined brachial plexus and cervical plexus block. Patients were positioned in the standard beach-chair configuration, with a 6–10 cm padded support placed beneath the scapula on the affected side to facilitate anatomical reduction of the clavicle.
Intraoperative data
Intraoperative data were extracted from surgical records, including incision length (cm), the number of C-arm fluoroscopy images taken, operative time (minutes), and estimated intraoperative blood loss (mL). Operative time was defined as the interval from skin incision to final wound closure.
Postoperative data
Visual Analog Scale (VAS) score
Postoperative pain was assessed using the VAS on postoperative days 1, 2, and 3, as well as at the time of discharge [16]. Pain intensity was classified as mild (0–4), moderate (5–8), or severe (9–10).
Assessment and follow-up
All patients were evaluated by orthopedic professionals at 6, 12, and 24 weeks postoperatively, and again at the time of internal fixation removal. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score [17, 18] and the Constant–Murley score [19, 20]. At each follow-up visit, complications were recorded, including: (1) changes in skin sensation; (2) deep wound infection; (3) nonunion; (4) hypertrophic scarring; and (5) implant failure, defined as screw loosening or dislodgment, fracture or deformation of the plate, or significant displacement at the fracture site.
Assessment of skin numbness
Skin sensory disturbances were assessed using both subjective and objective methods. Evaluations were routinely performed at 6, 12, and 24 weeks postoperatively, as well as at the time of implant removal. Patients were systematically questioned regarding numbness or altered sensation in the anterior chest or shoulder region. For those reporting such symptoms, objective assessment of superficial sensation was performed using light touch testing with a cotton swab, comparing the affected side with the contralateral side.
Surgical technique and rehabilitation protocol
Surgical procedure
MIPO
A 3–4 cm longitudinal incision was made over the proximal clavicle, starting medially from the acromioclavicular joint. Soft tissues were dissected to expose the clavicle. A 9–10-hole precontoured locking compression plate was selected. Under C-arm fluoroscopic guidance, a second 2–3 cm longitudinal incision was made near the distal clavicle, slightly offset laterally to avoid the fracture zone. A subperiosteal tunnel was created along the clavicle using a small periosteal elevator to connect both incisions. The plate was introduced through the tunnel with the aid of sleeves inserted into the distal incision. Following initial distal fixation, fracture reduction was achieved using forceps and guided traction, with temporary stabilization maintained by towel forceps. Final fixation was performed under multi-angle C-arm fluoroscopy, using three screws on each side of the fracture (Figs. 2 and 3).
Fig. 2.
Channel Establishment and Clavicular Anatomic Locking Plate Implantation Process. A, B Selection of an appropriately sized clavicular anatomic locking plate, incising to avoid the fracture ends; C Dissection of soft tissues above the periosteum to construct the channel; D Implantation of the clavicular anatomic locking plate along the established periosteal channel
Fig. 3.
MIPO Treatment of AO/OTA Type B3 displaced midshaft clavicle fractures. A Preoperative CT three-dimensional reconstructed images; B Intraoperatively utilizing reduction forceps for fracture reduction; C Fixation with clavicular anatomic locking plate; D Intraoperative C-arm fluoroscopy demonstrates optimal realignment of the fracture
ORIF
A 10–15 cm S-shaped incision centered over the fracture site was made to allow full exposure of the fracture ends. After periosteal stripping and removal of soft tissue debris, the fracture was reduced using reduction forceps, Kocher clamps, or Nice knots. Once satisfactory alignment was confirmed under C-arm fluoroscopy, an appropriately sized anatomical locking plate was positioned and secured with 3–4 screws on each side.
Postoperative rehabilitation
Patients in both surgical groups followed an identical postoperative rehabilitation protocol. The affected limb was supported with a forearm sling or triangular bandage for four weeks. During the first three months, patients were advised to avoid vigorous activity and heavy lifting. Functional exercises were introduced in a phased manner to promote recovery:
Weeks 0–4: Active range-of-motion exercises were encouraged for the elbow, wrist, and hand on the affected side, along with passive pendulum movements for the shoulder joint.
Weeks 4–6: Patients gradually transitioned to active pendulum movements of the shoulder.
Weeks 6–12: Rehabilitation progressed to full-range shoulder movements and resistance exercises.
This staged approach was designed to facilitate the functional recovery of the affected limb while minimizing the risk of complications.
Satisfaction survey
At 24 weeks postoperatively, overall satisfaction with the surgical outcome was assessed using a 5-point Likert scale [21]: 1 = extremely dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = extremely satisfied. For analytical purposes, patients were categorized into two groups: those scoring 3, 4, or 5 points were considered satisfied, while those scoring 1 or 2 points were classified as dissatisfied.
Statistical analysis
All statistical analyses were conducted using SPSS software, version 27.0.1 (IBM Corp., Armonk, NY, USA). Continuous variables were presented as mean ± standard deviation and compared between groups using the independent samples t-test. Categorical variables were expressed as frequencies and percentages, and analyzed using the chi-square test (χ2). A p-value < 0.05 was considered statistically significant.
Results
Preoperative characteristics
A total of 79 patients met the inclusion criteria, with 32 assigned to the MIPO group and 47 to the ORIF group. Baseline characteristics were comparable between the two groups, including age (41.66 ± 11.32 years vs. 42.53 ± 11.18 years, p = 0.731), sex distribution (male/female: 18/14 vs. 31/16, p = 0.383), BMI (23.24 ± 2.21 vs. 23.86 ± 1.74, p = 0.170), smoking history (25.0% vs. 29.8%, p = 0.641), alcohol use (12.5% vs. 21.3%, p = 0.316), hypertension (18.8% vs. 10.6%, p = 0.798), diabetes mellitus (15.6% vs. 14.9%, p = 0.929), injury mechanism (p = 0.406), AO/OTA fracture classification (p = 0.635), and Robinson classification (p = 0.536). No statistically significant differences were observed in any of these parameters (Table 1).
Table 1.
Preoperative general information between ORIF and MIPO groups
| Variable | ORIF | MIPO | D-value |
|---|---|---|---|
| Number | 47 | 32 | |
| Age (years) | 42.53 ± 11.18 | 41.66 ± 11.32 | 0.731 |
| Sex | 0.383 | ||
| Male | 31 | 18 | |
| Female | 16 | 14 | |
| Current Smoker (%) | 14 (29.79%) | 8 (25%) | 0.641 |
| Heavy alcoholics (%) | 10 (21.28%) | 4 (12.5%) | 0.316 |
| History of hypertension (%) | 5 (10.64%) | 6 (18.8%) | 0.798 |
| Diabetic status (%) | 7 (14.89%) | 5 (15.63%) | 0.929 |
| Body mass index (kg/m2) | 23.86 ± 1.74 | 23.24 ± 2.21 | 0.170 |
| Trauma mechanism | 0.406 | ||
| Motor vehicle accident | 18 | 17 | |
| Fall from height | 5 | 2 | |
| Fall from level | 24 | 13 | |
| AO/OTA classification (clavicle, diaphysis, 15-B) | 0.635 | ||
| Simple (15-B1) | 20 | 17 | |
| Wedge (15-B2) | 17 | 10 | |
| Comminuted (15-B3) | 10 | 5 | |
| Robinson classification (clavicle, Type 2B) | 0.536 | ||
| Simple or wedge comminuted (Type 2B1) | 37 | 27 | |
| Isolated or communuted segmental (Type 2B2) | 10 | 5 | |
BMI Body mass index, p > 0.05, no significance, OTA Orthopaedic Trauma Association
Intraoperative parameters
Significant differences in intraoperative parameters were observed between the two groups (Table 2). The mean incision length was significantly greater in the ORIF group compared to the MIPO group (12.25 ± 1.60 cm vs. 6.42 ± 0.48 cm, p < 0.001). Although the ORIF group required fewer C-arm fluoroscopy exposures (7.19 ± 1.21 vs. 10.41 ± 1.90, p < 0.001), the MIPO group demonstrated significantly less intraoperative blood loss (45.44 ± 4.27 mL vs. 52.81 ± 6.60 mL, p < 0.001) and a shorter operative duration (54.22 ± 5.14 min vs. 61.15 ± 6.01 min, p < 0.001).
Table 2.
Intraoperative information between ORIF and MIPO groups
| Variable | ORIF | MIPO | p-value |
|---|---|---|---|
| Number | 47 | 32 | |
| Proportional length difference (cm) | 12.25 ± 1.60 | 6.42 ± 0.48 | < 0.001 |
| C-arm fluoroscopy times | 7.19 ± 1.21 | 10.41 ± 1.90 | < 0.001 |
| Operation time(min) | 61.15 ± 6.01 | 54.22 ± 5.14 | < 0.001 |
| Intraoperative blood loss(mL) | 52.81 ± 6.60 | 45.44 ± 4.27 | < 0.001 |
p < 0.05, significant difference
Postoperative information
Postoperative VAS score
VAS scores were significantly lower in the MIPO group compared to the ORIF group on postoperative days 1 (5.63 ± 0.83 vs. 6.19 ± 0.92, p = 0.007), 2 (4.19 ± 0.93 vs. 4.98 ± 0.74, p < 0.001), and 3 (3.34 ± 1.00 vs. 4.06 ± 0.76, p = 0.001) (Table 3).
Table 3.
Postoperative information between ORIF and MIPO groups
| Variable | ORIF | MIPO | p-value |
|---|---|---|---|
| Number | 47 | 32 | |
| Hospital stays (day) | 6.79 ± 1.25 | 6.44 ± 1.08 | 0.201 |
| Internal fixation removal (month) | 13.19. ± 1.39 | 12.75 ± 1.24 | 0.153 |
| DASH score | |||
| Week 6 | 32.87 ± 2.22 | 32.16 ± 3.28 | 0.251 |
| Week 12 | 22.87 ± 2.66 | 22.72 ± 3.81 | 0.833 |
| Week 24 | 11.66 ± 2.57 | 11.84 ± 3.47 | 0.787 |
| Internal fixation removal | 4.02 ± 1.50 | 3.59 ± 1.39 | 0.203 |
| Constant-Murley score | |||
| Week 6 | 65.94 ± 3.33 | 66.25 ± 3.88 | 0.701 |
| Week 12 | 74.40 ± 3.57 | 73.81 ± 2.83 | 0.435 |
| Week 24 | 84.98 ± 2.58 | 85.13 ± 2.87 | 0.814 |
| Internal fixation removal | 93.51 ± 1.68 | 94.03 ± 1.45 | 0.157 |
| VAS score | |||
| Day 1 | 6.19 ± 0.92 | 5.63 ± 0.83 | 0.007 |
| Day 2 | 4.98 ± 0.74 | 4.19 ± 0.93 | < 0.001 |
| Day 3 | 4.06 ± 0.76 | 3.34 ± 1.00 | 0.001 |
| Complications | |||
| Nonunion | 0 | 0 | |
| Implant failure or screw loosening | 0 | 0 | |
| Deep infection | 0 | 0 | |
| Hypertrophic scar | 1 | 0 | 0.595 |
| Skin numbness | 18 (38.3%) | 4 (12.5%) | < 0.001 |
VAS Visual Analog Scale, p < 0.05, significant difference
Postoperative DASH score and constant-murley score
Functional recovery, assessed by the DASH and Constant-Murley scores, improved steadily over time in both groups. At 6 weeks, DASH scores were 32.87 ± 2.22 (ORIF) versus 32.16 ± 3.28 (MIPO, p = 0.251); at 12 weeks, 22.87 ± 2.66 versus 22.72 ± 3.81 (p = 0.833); at 24 weeks, 11.66 ± 2.57 versus 11.84 ± 3.47 (p = 0.787); and at implant removal, 4.02 ± 1.50 versus 3.59 ± 1.39 (p = 0.203). Similarly, Constant-Murley scores showed no significant differences at 6 weeks (65.94 ± 3.33 vs. 66.25 ± 3.88, p = 0.701), 12 weeks (74.40 ± 3.57 vs. 73.81 ± 2.83, p = 0.435), 24 weeks (85.13 ± 2.87 vs. 84.98 ± 2.58, p = 0.814), or at implant removal (93.51 ± 1.68 vs. 94.03 ± 1.45, p = 0.157). These results indicate comparable functional recovery between the two surgical techniques, with no statistically significant differences observed (Table 3).
Postoperative complications
No cases of deep infection, nonunion, or implant failure were observed in either group (Table 3). One case of hypertrophic scarring was reported in the ORIF group (p = 0.595). Postoperative skin numbness occurred in 18 patients in the ORIF group (38.2%) and in 4 patients in the MIPO group (12.5%), demonstrating a statistically significant difference in favor of MIPO (p < 0.001).
Duration of skin numbness
A total of 18 patients in the ORIF group and 4 patients in the MIPO group experienced sensory disturbances. At the 6-week postoperative follow-up, 15 patients in the ORIF group continued to report sensory abnormalities, with improvement observed in 3 patients, while all 4 patients in the MIPO group still exhibited altered sensation. By 12 weeks postoperatively, sensory disturbances persisted in 11 patients in the ORIF group and 3 patients in the MIPO group. At the 6-month follow-up, 7 patients in the ORIF group and 1 in the MIPO group remained symptomatic. By the time of internal fixation removal, only 1 patient in the ORIF group reported mild residual sensory symptoms, whereas complete resolution was observed in all patients in the MIPO group (Table 4).
Table 4.
Improvement of postoperative skin numbness in ORIF and MIPO groups
| Variable | ORIF | MIPO |
|---|---|---|
| At discharge | 18 (38.3%) | 4 (12.5%) |
| Week 6 | 15 (31.9%) | 4 (12.5%) |
| Week 12 | 11 (23.4%) | 3 (9.4%) |
| Month 6 | 7 (14.9%) | 1 (3.1%) |
| Internal fixation removal | 1 (2.1%) | 0 |
Patient satisfaction
At 24 weeks postoperatively, 29 of 32 patients in the MIPO group (90.6%) reported satisfaction with the surgical outcome, compared with 34 of 47 patients in the ORIF group (72.3%), demonstrating a statistically significant difference in favor of MIPO (p < 0.001) (Table 5).
Table 5.
Postoperative satisfaction between ORIF and MIPO groups [21]
| Variable | ORIF | MIPO | p-value | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Number | 47 | 32 | |||||||||
| Likert Grade | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 | |
| Number | 2 | 11 | 10 | 16 | 8 | 0 | 3 | 4 | 14 | 11 | |
| Satisfied | 34 (72.3%) | 29 (90.6%) | < 0.001 | ||||||||
| Dissatisfied | 13 (27.7%) | 3 (9.40%) | |||||||||
p < 0.05, significant difference
Discussion
This retrospective case–control study demonstrates that both MIPO and ORIF are effective treatment options for DMCFs, yielding satisfactory postoperative functional outcomes. However, MIPO showed significant perioperative advantages, including shorter incision length, reduced intraoperative blood loss, shorter operative duration, a lower incidence of neurological complications, and higher patient satisfaction. These benefits are primarily attributed to the closed reduction strategy employed in MIPO, which preserves the periosteal blood supply and minimizes disruption to surrounding soft tissues. By avoiding direct exposure of the fracture site, MIPO creates a more favorable biological environment for bone healing.
In contrast, ORIF requires extensive soft tissue dissection under direct visualization, particularly in cases of comminuted fractures, resulting in increased intraoperative bleeding and prolonged operative time. Although MIPO necessitates frequent intraoperative fluoroscopy, this did not significantly affect surgical efficiency. Moreover, with growing surgical experience, the frequency of fluoroscopy use is expected to decrease.
While ORIF was associated with a slightly higher incidence of nonunion compared to MIPO, the overall rates remained low. Notably, nonoperative management carries a higher risk of nonunion. A study by Zheng et al. [22] found no significant difference in fracture union time between MIPO and ORIF. In our study, all patients were followed until implant removal, and no cases of nonunion were observed. Additionally, there was no statistically significant difference in the timing of implant removal between the two groups (p > 0.05). However, due to the relatively long intervals between follow-up visits, it was not possible to precisely determine the time of complete fracture healing in either group.
Cutaneous sensory disturbance in the surgical area is a common complication following midshaft clavicle fracture surgery, primarily resulting from injury to the supraclavicular nerve branches. This nerve typically has 2–3 branches, and approximately 97% of individuals have branches that cross over the clavicle [23]. Although some studies have proposed a “nerve-free safety zone” located 2.7 cm medial to the sternoclavicular joint and 1.9 cm lateral to the acromioclavicular joint [24], individual anatomical variation makes intraoperative nerve preservation challenging.
Postoperatively, patients may experience pain or numbness in the surgical site or anterior chest. Previous studies have demonstrated that MIPO significantly reduces the incidence of supraclavicular nerve injury compared to ORIF [11, 25]. Hu et al. [26] suggested that combining ORIF with the wide-awake local anesthesia no tourniquet (WALANT) technique may further decrease the risk of nerve injury. Whether the combination of MIPO and WALANT offers synergistic benefits remains to be determined.
In the present study, no nerve-protective measures were employed. During follow-up, 18 patients (38.2%) in the ORIF group reported sensory disturbances in the surgical or anterior chest region, compared to only 4 patients (12.5%) in the MIPO group. This difference is likely attributable to the smaller incision size and more anatomically favorable placement used in MIPO. In the few cases of sensory disturbance in the MIPO group, anatomical variation in nerve distribution may have contributed. Although most sensory symptoms resolved spontaneously within 3 to 12 months postoperatively without the need for additional intervention, they may negatively affect patient comfort during early rehabilitation.
Despite receiving identical postoperative analgesic regimens, patients in the MIPO group reported superior early subjective experiences. This is likely attributable to the smaller incision size, reduced soft tissue dissection, lower local tension, and diminished inflammatory response associated with the MIPO technique. Given the relatively thin subcutaneous tissue in the clavicular region, MIPO results in less tissue trauma, leading to milder postoperative pain. In contrast, the ORIF technique involves a longer incision and greater implant-related irritation, which may contribute to increased swelling and higher incision tension, thereby intensifying postoperative pain.
Hypertrophic scarring is a common postoperative skin reaction, influenced by factors such as individual predisposition, the extent of soft tissue damage, suturing technique, and the presence of local infection. During the follow-up period, only one case of hypertrophic scarring was observed, which occurred in the ORIF group. All patients underwent subcuticular closure using fine absorbable sutures to reduce incision tension and minimize scar formation, while also avoiding discomfort associated with suture removal. From an aesthetic perspective, MIPO incisions are typically 2–3 cm in length and are aligned with the skin tension lines over the medial clavicle, resulting in less visible postoperative scarring. Lateral incisions are positioned near the shoulder and are easily concealed by clothing, making MIPO particularly favorable for patients with high cosmetic expectations. In contrast, ORIF incisions are longer, more exposed, and generally less cosmetically acceptable. Follow-up findings suggest that postoperative sensory disturbances and scar appearance are key factors influencing patient satisfaction, which may partly explain the observed differences in satisfaction rates between the two surgical techniques.
This study represents one of the more comprehensive cohort analyses in recent years comparing MIPO and ORIF for the treatment of DMCFs. Through systematic follow-up and evaluation, we assessed differences in fracture healing, perioperative parameters, postoperative complications, pain management, and cosmetic outcomes. The inclusion of long-term follow-up data enhances the clinical relevance and practical applicability of our findings. Our results further confirm the clinical advantages of MIPO, particularly in complex or comminuted fractures, where the principles of bridge plating and functional reduction enable stable union and favorable functional recovery. Additionally, this study highlights key factors influencing patients’ postoperative experience—such as sensory disturbances and scar appearance—thereby reinforcing the importance of a patient-centered, individualized treatment approach. Collectively, these findings contribute to a more robust evidence base for surgical decision-making in the management of DMCFs.
This study has several limitations. First, it was a single-center retrospective analysis, which limits the ability to establish causal relationships. Second, patient allocation was not randomized; ORIF procedures were primarily performed earlier in the study period, whereas MIPO was adopted in later years. This temporal separation may introduce selection bias. Third, the sample size in the MIPO group was relatively small, potentially limiting the statistical power to detect rare complications or subtle intergroup differences. Future prospective, multi-center studies with larger cohorts and randomized controlled designs are warranted to validate our findings and to more comprehensively evaluate the benefits and risks associated with MIPO in the treatment of DMCFs.
Conclusion
Both MIPO and ORIF are effective surgical options for the management of DMCFs. Although functional recovery outcomes were comparable between the two techniques, MIPO demonstrated clear advantages in terms of reduced surgical trauma, accelerated postoperative recovery, lower complication rates, and higher patient satisfaction. These findings support the wider clinical adoption of MIPO, particularly in healthcare settings that emphasize minimally invasive approaches and enhanced recovery protocols.
Acknowledgements
The authors would like to express their sincere gratitude to the Orthopedic Center of the Second Affiliated Hospital of Guangdong Medical University for their valuable support and assistance throughout the course of this study.
Authors’ contributions
Conception and design of study: Kai Li, Huaibo Wang; acquisition of data: Ruiyang Xue, Zhuming Chen, Liuhan Zhou; analysis data: Yannan Zhou,Kaiyuan Zhu, Sijing Liu; drafting the manuscript: Kai Li, Huaibo Wang; revising the manuscript critically for important intellectual content: Kai Li, Weitao Guo. All authors read and approved the final version of the manuscript.
Funding
This work was supported by High Level-Hospital Research Platform Key Cultivation Program of Zhanjiang City of China, (No. 2021A05087); Disease Prevention and Control Key Program of Zhanjiang City of China, (No. 2022A01144); The Guangdong Medical University Science and Technology Innovation Special Fund (No. GDMULCJC2024079); The Guangdong Medical University Science and Technology Innovation Special Fund (No. GDMULCJC2024088).
Data availability
The datasets used during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This retrospective chart review involving human participants was conducted in accordance with the ethical standards of the institutional and national research committees, as well as the 1964 Declaration of Helsinki and its later amendments or comparable ethical guidelines. All participants were fully informed of the surgical procedures prior to enrollment and provided written informed consent. The study protocol was approved by the Institutional Review Board of The Second Affiliated Hospital of Guangdong Medical University (Approval No. YSC2024-066–01).
Consent for publication
Not applicable. This study did not include any identifiable images, personal data, or clinical details that could compromise participant anonymity.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Huaibo Wang and Ruiyang Xue authors contributed equally to this work.
Contributor Information
Sijing Liu, Email: lsjlm808@163.com.
Weitao Guo, Email: guoweitao2000@sina.com.
Kai Li, Email: kai257257@outlook.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used during the current study are available from the corresponding author on reasonable request.