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Optimal plate position in minimally invasive plate osteosynthesis for mid-shaft clavicle fractures: simulation using 3D-printed models of actual clinical case

Abstract
Introduction This study evaluated the optimal anatomical locking plate position using three-dimensional printed models of the clavicle. Materials and methods Three-dimensional models of the fractured clavicle were reproduced from seventeen patients who underwent minimally invasive plate osteosynthesis (MIPO) procedures. The fracture location?the percentage of the distal fragment length compared to the entire clavicle?ranged from 30?44%. We evaluated four commercially available plate systems for position and fitting with the bone. After reducing the fracture on each three-dimensional model, we determined the optimal plate and its position. Results The anatomical plate fitted well when positioned in the middle of the clavicle for a fracture location ranging from 40 to 60%. When the fracture location was 30?40%, the anatomical plate fit well onto the bone model only in 36% of clavicles; otherwise, the reversed position of the anatomical plate or the lateral plate fit well. The anatomical plate was found to be unsuitable when the fracture location was less than 30%; in this case, the lateral plate was the best fit. Conclusion Fitting the anatomical plate in MIPO for clavicle fractures depends on the fracture location. This can help surgeons determine the optimal plate for clavicle MIPO.

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