Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Mudd, Christopher D.; Quigley, Kevin; Gross, Lyndon B.

doi:10.1007/s11999-011-1867-1

Cited by 46 publications

(35 citation statements)

References 18 publications

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“…The RCP intended to provide a less invasive alternative to plate fixation. However, the incidence of complications of RCP was relatively higher, including nonunion, revision surgery, and soft tissue complications [28]. The high complications may be related to the inherent weak biomechanical stability of the RCP.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures

Niu

Wong

et al. 2016

Injury

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Section: Discussionmentioning

confidence: 99%

Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures

Niu

Wong

et al. 2016

Injury

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“…The subcutaneous position of the IM device contributes to the overlying skin necrosis posteriorly, which is clearly a concern for bacterial seeding of the implant, although deep infections or microbiologically confirmed infections are rarely reported in literature. 13,15 We also found only two patients with positive microbiology results, which may suggest a primary inflammatory process rather than an infective one. The senior surgeons became suspicious about the apparent increase in wound complications and during the last IM fixation undertaken on a young male, noted blackening and heating of the guide wire used for retrograde drilling.…”

mentioning

confidence: 67%

“…5 Wijdicks et al suggested that infection is defined as redness, swelling, purulent discharge, a positive wound culture, and/or when prescription of antibiotics was given, and irritation was caused by prominence or protrusion of the implant material. 6 There are only few articles [7][8][9][10][11][12][13] reporting on these complications and even fewer 14,15 explore their treatments and outcomes, especially with IM cannulated screws. 16,17 Our study was designed to focus on the treatment and outcome of patients with clavicle fractures treated with open reduction and internal fixation, who had local wound complications.…”

Section: Introductionmentioning

confidence: 99%

Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?

Dömös

Tytherleigh-Strong

Rensburg

2017

J Orthop Surg (Hong Kong)

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Purpose: Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications. There is little information about outcome and management of local wound complications after clavicle fracture fixations. Methods: Ninety-seven patients underwent open reduction and internal fixation, 17 were treated with IM screw fixation and 80 with plate fixation. Wound complication occurred in eight patients (8.2%) and rates differed significantly between IM and plate fixations (29.4% vs. 3.8%). Patients were assessed on average 58.3 months with visual analogue pain scores (VASs), Oxford Shoulder Score (OSS), and QuickDash (QD) score. Results: Five patients had wound breakdown and three patients had wound erythema. In seven patients with stable fixation, it was possible to "dress and suppress" with average 3 weeks of oral antibiotics. One patient had unstable fixation and required longer antibiotic treatment with early screw removal. One patient developed a chronic discharging wound, requiring debridement and later plate removal. At final follow-up, all wounds remained healed, bony union was achieved in all. The average scores were: VAS 1, OSS 46, and QD 4.5. Conclusions: Good function with dry healed wound and united clavicle can be achieved. Further studies are required to investigate the difference in soft tissue complication rates, which may be due to the IM technique of retrograde drilling with a guide wire and due to aseptic thermal bone necrosis, rather than true infection.

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“…14,[23][24][25][26][27][28][29][30][31][32] In addition, 6 studies included treatment of nonunions or delayed unions and did not make a distinction with the treatment of acute fractures when describing the complications, 16,33-37 2 studies were surgical technique papers, 38,39 1 study reported on plate fixation, 40 1 study lacked a definition for dislocation, 41 1 study did not make a distinction between angulation and comminution, 42 1 study included fewer than 10 patients 15 and, in 1 study, 11 authors reported on a previously reported patient population. Reported rates for major complications like bonehealing problems and deep infections requiring implant removal were no higher than 7%.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures

et al. 2013

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Background:The number of displaced midshaft clavicle fractures treated surgically is increasing, and open reduction and intramedullary fixation is an emerging surgical treatment option. The study quality and scientific levels of published evidence in which possible complications of this treatment are presented vary greatly. Methods:We performed systematic computer-based searches of EMBASE and PubMed/MEDLINE. Studies included for review reported complications after intramedullary fixation alone or in comparison to either treatment with plate fixation and/or nonoperative treatment. The Level of Evidence rating and Quality Assessment Tool were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence.Results: Six articles were eligible for inclusion and final quality assessment; 3 studies were graded the highest level of evidence. Major complications like bone-healing problems and deep infections requiring implant removal were reported at a rate no higher than 7%. Reported rates for minor complications, such as wound infection and implant irritation that could be resolved without further surgery, were as high as 31%. Conclusion:The noted rates for major complications requiring additional surgery were low, but implant-related problems that require additional surgery might present with high prevalence. Owing to routine implant removal, treatment with intramedullary fixation often requires an additional surgical procedure.Contexte : Le nombre de fractures déplacées de la diaphyse claviculaire traitées chirurgicalement est en hausse et la réduction ouverte avec fixation intramédullaire est une option chirurgicale émergente. La qualité des études et le niveau scientifique des preuves publiées concernant les complications possibles de ce traitement varient beaucoup.Méthodes : Nous avons procédé à une interrogation systématique des bases de données informatiques EMBASE et PubMed/MEDLINE. Les études retenues pour examen faisaient état de complications après le recours à la fixation intramédullaire seule ou comparée à un traitement par plaque et vis et(ou) un traitement non chirurgical. Nous avons utilisé le classement par niveaux de preuve ou un outil d'évaluation qualitative pour mesurer la qualité méthodologique des études. Les études retenues ont été classées selon leur niveau de preuve.Résultats : Nous avons retenu 6 articles pour inclusion et évaluation finale de leur qualité; 3 des études présentaient le niveau de preuve le plus élevé. Les complications majeures, notamment des problèmes de cicatrisation de l'os et d'infection profonde nécessitant le retrait de l'implant, ont été signalés selon un taux n'excédant pas 7 %. Les taux de complications mineures rapportées, telles qu'infection de plaie et irritation due à l'implant, qui ont pu rentrer dans l'ordre sans autre chirurgie, se sont élevés à 31 %. Conclusion :Les taux signalés de complications majeures ayant nécessité une autre chirurgie ont été faibles, mais les problèmes relatifs aux implants ay...

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Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Abstract: Background Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing.

Cited by 46 publications

References 18 publications

Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures

Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures

Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?

Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures

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