Clinical outcomes of Nice knot-assisted locking plate for preserving periosteum internal fixation in comminuted clavicle fractures: A retrospective study.

Abstract

IntroductionClavicular fractures, particularly comminuted fractures, are common injuries that can affect shoulder function and upper limb mobility. The management of these fractures, especially using surgical approaches and fixation methods, remains a key area of clinical focus. Preserving the periosteum during surgery may improve fracture healing and reduce complications. This study explored the clinical efficacy of a periosteum-preserving surgical technique combined with a Nice knot-assisted locking plate for treating comminuted clavicular fractures.MethodsA total of 85 patients with comminuted clavicular fractures were included in this retrospective study. According to the Allman classification, 56 (65.9%) cases were type IC, 19 (22.4%) were type II, 9 (10.9%) were type III, and 1 (1.1%) involved comminuted fractures across the entire clavicle. All patients underwent surgical treatment using a periosteum-preserving approach combined with a Nice knot-assisted locking plate. Fracture healing time, upper limb function (measured via Constant-Murley score and disabilities of the arm, shoulder, and hand questionnaire), and postoperative complications were assessed 6 and 12 months postoperatively.ResultsThe median healing time was 13 weeks, with no cases of nonunion reported. At 6 months postoperatively, the Constant-Murley and disabilities of the arm, shoulder, and hand scores were excellent. Although a statistically significant difference (P < 0.05) was observed in these scores between 6 and 12 months, all patients reported satisfactory recovery of shoulder function and upper limb mobility. No significant differences (P > 0.05) in fracture healing time or upper limb function recovery were observed across different types of clavicular fractures. Six (7.1%) patients experienced temporary numbness in the subclavian region, which gradually resolved by the final follow-up.ConclusionThe periosteum-preserving approach with Nice knot-assisted locking plate fixation proved to be an effective and reliable treatment for comminuted clavicular fractures. The technique was associated with favorable healing times, excellent functional outcomes, and low complication rates. Preservation of the periosteum and soft tissue during surgery may considerably reduce intraoperative trauma and improve postsurgical recovery. Further studies with larger sample sizes and longer follow-up periods are needed to confirm the long-term benefits of this approach.