Minimally invasive fixation of midclavicular fractures with threaded elastic intramedullary nails

Bi, Hongbin; Wang, Yongqing; Xiong, Qingguang; Li, Yi; Zhao, Zhihui; Yang, Zhiqiang

doi:10.1007/s00590-015-1633-2

Cited by 5 publications

(7 citation statements)

References 31 publications

(33 reference statements)

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“…Another type of fixation described was the Sonoma CRx (Arthrex, Naples, FL, USA) for which 6 studies (three level I, [67][68][69] one level II, [70] one level III [71] and one level IV [72]) were identified. Less frequently described intramedullary fixation devices were the threaded titanium elastic nails (Kang Li Min Medical Devices Co. Ltd., Tianjin, China), [73][74][75] the Knowles pin (Zimmer Biomet, Warshaw, IN, USA) [76][77][78][79] and one study describing a second generation Titanium elastic nail (Puwei Medical Appliances Inc., Shanghai, China) [80]. Table 1 displays study characteristics including population description, type of intramedullary device, functional outcome scores, and type and number of complications.…”

Section: Resultsmentioning

confidence: 99%

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Functional outcomes and complications of intramedullary fixation devices for Midshaft clavicle fractures: a systematic review and meta-analysis

Hoogervorst

Dam²,

Hannink

2020

BMC Musculoskelet Disord

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Background: An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures (DMCF) using plate osteosynthesis, is internal fixation by means of intramedullary fixation devices. These devices differ considerably in their specifications and characteristics and an evaluation of their clinical results is warranted. The aim of this systematic review is to generate an overview of functional outcomes and complications in the management of DMCF per available intramedullary device. Methods: A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until February 2020. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates were rated and described according to the recommendations of the GRADE working group. Results: Sixty-seven studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the Titanium Elastic Nail and Sonoma CRx report an average Constant-Murley score of 94.4 (95%CI 93-95) and 94.0 (95%CI 92-95) respectively (GRADE High). The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence 20% (95%CI 14-26) and 12% (95%CI 8-18), are most common (GRADE Moderate). For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 22% (95%CI 13-35) (GRADE Low). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 6% (95%CI 2-17) of cases (GRADE Very low).

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Section: Resultsmentioning

confidence: 99%

“…Meta-analysis was only possible for infection [73][74][75] and the pooled incidence was 5% (95%CI 1-34 in 106 clavicles).…”

Section: Studies Concerning a Threaded Elastic Nailmentioning

confidence: 99%

Functional outcomes and complications of intramedullary fixation devices for Midshaft clavicle fractures: a systematic review and meta-analysis

Hoogervorst

Dam²,

Hannink

2020

BMC Musculoskelet Disord

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“…1) [57,58] one level II, [59] one level III [60] and one level IV [61]) were identified. Less frequently described intramedullary fixation devices were the threaded titanium elastic nails (Kang Li Min Medical Devices Co. Ltd., Tianjin, China), [62][63][64] the Knowles pin (Zimmer Biomet, Warshaw, IN, USA) [65][66][67][68] and one study describing a second generation Titanium elastic nail (Puwei Medical Appliances Inc, Shanghai, China).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported on persistent pain as a complication [58,60] and 1 study mentions the occurrence of a delayed union. [57] Studies concerning a threaded elastic nail Meta-analysis was only possible for infection [62][63][64] and the pooled incidence was 5% (95%CI 1-34).…”

Section: Meta-analysismentioning

confidence: 99%

Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

Hoogervorst¹,

Dam²,

Hannink³

2019

Preprint

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Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures using plate osteosynthesis, is internal fixation by means of an intramedullary fixation device. These devices differ considerably in their specifications and characteristics and an adequate evaluation of their clinical results is warranted. Methods A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases were searched from inception until January 2018. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Results Fifty-eight studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the titanium elastic nail and Sonoma CRx report an average Constant-Murley score of 94.2 (96%CI 93.2-95.3) and 93.4 (95%CI 92.1-94.7) respectively. The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence of 20% (95%CI 14-27) and 13% (95%CI 9-20), are major contributors to the total complication rate. For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 21% (95%CI 11-35). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 7% (95%CI 2-22) of cases. Conclusion Although most studies were of low quality, in general, good functional results and union rates irrespective of the type of device are found in the reviewed literature. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

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“…Studies suggested that intramedullary fixation is a more advantageous method for the treatment of mid‐shaft clavicle fractures, achieving excellent aesthetic and early recovery after surgery. For intramedullary fixation, the most common devices in clinics used are Knowles pinning, elastic stable titanium intramedullary nailing, Rockwood clavicle pin, Acumed clavicle rod, Hagie pin, expandable elastic locking intramedullary nail and threaded elastic intramedullary nail. All these devices have their own merits and demerits.…”

Section: Introductionmentioning

confidence: 99%

Bilaterally Threaded, Minimal Invasive, Elastic Locking Intramedullary Nailing (ELIN) for the Treatment of Clavicle Fractures

Ullah

Khan

Wang

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate and present the effectiveness of this innovatively designed, elastic locking intramedullary nail (ELIN) in fixation of clavicle fractures.Methods: The study included 38 patients from July 2014 to July 2017. All of them received intramedullary fixation treated with ELIN, 22 were males and 16 females. The mean age of the patients was 54 years. There were twenty right-side and 18 left-side clavicular fractures. Radiographs were taken to assess the fracture type: 21 were type A, 16 type B, and one type C. General anesthesia or cervical block was given to all patients. A small incision of 3-5 cm was given only to those who needed mini-open reduction. The administration of ELIN and reduction of the fracture was made sure with a C arm machine. After a follow-up of 8 to 33 months, the clinical outcomes were assessed and evaluated. The constant scores and disabilities of the arm, shoulder and hand questionnaire (DASH) were used to determine the outcomes and functional status of the patients. The study was done accordingly to the guidelines provided by the ethics committee.Results: Mean operation time was 25.63 min. Mean follow-up time was 16.5 months. The rate of closed reduction and open reduction was 84% and 16% respectively. There was no shortening of the clavicle. There was no breakage of the nail, though bending of the nail occurred in one patient. Superficial skin infection occurred in three patients at insertion points or the nail tip which was embedded subcutaneously. Skin erosion with nail exposure occurred in a patient with no significant infection. All the other patients had excellent shoulder function. A mini scar was observed in seven patients all the other patients had no scar. Asymmetry was observed in three patients. The mean Constant score was 98.47 and the mean DASH score was 1.55 at the last follow-up. The implant was removed in all the patients.Conclusion: Clavicular fractures treated with ELIN is minimally invasive, which presents a safe and novel surgical technique with less complications and a high success rate, excellent aesthetic and quick recovery after surgery. ELIN restores the micro-dynamic stress at the fracture ends and promotes fracture healing, keeps intact the fracture hematoma and maintains the blood supply, accelerates healing and thus leads to faster osseous healing and better restoration of clavicle length.

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Minimally invasive fixation of midclavicular fractures with threaded elastic intramedullary nails

Abstract: Treatment Study, Level II.

Cited by 5 publications

References 31 publications

Functional outcomes and complications of intramedullary fixation devices for Midshaft clavicle fractures: a systematic review and meta-analysis

Functional outcomes and complications of intramedullary fixation devices for Midshaft clavicle fractures: a systematic review and meta-analysis

Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

Bilaterally Threaded, Minimal Invasive, Elastic Locking Intramedullary Nailing (ELIN) for the Treatment of Clavicle Fractures

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