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Authors of section


Jonas Andermahr, Michael McKee, Diane Nam

Executive Editor

Joseph Schatzker

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MIO - Bridge plate

1. Introduction


This procedure is extremely difficult and should not be performed except by very expert upper extremity surgeons.

The goal of treatment

The goal of treatment for a multifragmentary fracture of the shaft of the clavicle requires restoration of the appropriate alignment length and rotation.

This may be achieved with a minimally invasive plate osteosynthesis technique (MIPO). It requires less soft tissue dissection, preserves blood supply and biology to improve healing.

mio bridge plate

Plate selection

We will here show the procedure with a precontoured clavicular plate.

Note: Even a precontoured plate may also require some additional contouring.

The use of the image intensifier is also required to verify the correct application of the plate when using a MIPO technique.

mio bridge plate

When the fracture location is more lateral or more medial, the bone quality near the metaphysis may not offer sufficient screw purchase. In these instances, a plate offering additional screw fixation may be required (eg, longer plate, periarticular plate, locking head screws).

orif pre contoured distal plate

2. Patient preparation and approach

Patient preparation

This procedure is normally performed with the patient either in a beach chair or a supine position.


For this procedure a MIO anterior approach is used.

mipo   anterior approach

3. Reduction and fixation

In MIPO of clavicular fractures, the following reduction techniques are useful:

Shoulder manipulation with inline traction and an external rotation movement often helps to reduce the fracture. (The shoulder should be draped free.)

flexible intramedullary nail

Pointed reduction clamps can be used either percutaneously or through small stab incisions.

mio bridge plate

If the fracture zone is extensive and normal anatomic landmarks cannot be restored, one uses a pre-contoured plate which is then fixed to the medial side first, as this side cannot tolerate malalignment. The lateral end of the clavicle is then reduced to the plate by manipulation. Once reduced, the reduction is maintained with a percutaneous applied clamp, and the lateral end of the plate is fixed to the clavicle with one screw. C-arm control of the reduction is then carried out. If deemed satisfactory, fixation of the plate on the medial and lateral end of the plate is completed.

mio bridge plate

The superior surface of the lateral fragment is flat and readily identified. Reduction of the plate to the superior flat surface of the lateral segment will often restore the correct rotation.

mio bridge plate

Plate application

The precontoured plate is inserted through the skin incision medially or laterally into a subcutaneous tunnel over the clavicle. Two positions are possible, superiorly or anteriorly.

mio bridge plate

Cortex screws are inserted first, one on each end of the plate, to bring the plate close to bone.

mio bridge plate

Fracture reduction and plate position is checked. If satisfactory, additional cortical and/or locking screws are inserted to complete the fixation.

If the fracture reduction and plate position are not satisfactory, the screws may be loosened and reduction procedure repeated.

diaphyseal multifragmentary fragmentary segmental

4. Aftercare

The aftercare can be divided into 4 phases:

  1. Inflammatory phase (week 1–3)
  2. Early repair phase (week 4–6)
  3. Late repair and early tissue remodeling phase (week 7–12)
  4. Remodeling and reintegration phase (week 13 onwards)

Full details on each phase can be found here.