Outcomes of Displaced Midclavicular Fractures in Adults Treated With Antegrade Titanium Elastic Intramedullary Nails

Abstract

BACKGROUND Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications. There is an increasing trend for operative management. Plating and intramedullary nailing are the most popular surgical options. The use of intramedullary titanium nails requires smaller incisions, avoidance of significant soft tissue stripping, minimal complications, and early return to work. The aim of the study was to evaluate the clinical outcome of displaced midclavicular fractures (DMCFs) in adults treated with titanium elastic nails (TENs). MATERIAL AND METHODS Prospective study was conducted between 2009 and 2013 in which 34 patients (26 males and 8 females) with mean age of 39.1 years with OTA type B DMCFs underwent surgical fixation with TENs. Evaluation done by Constant and DASH scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. RESULTS Closed reduction was possible in 20 patients (58.82%). All the patients achieved clinical and radiological union at 9.38±1.44 weeks. The final Constant and DASH scores were 93.37±3.06 and 5.63±2.66. There were no major complications, only minor complications of shortening >0.5 cm (n=3, 8.82%), superficial infection (n=3, 8.82%) and medial TEN protrusion (n=7, 20.58%). CONCLUSION The intramedullary fixation of DMCFs with TENs is a minimally invasive, safe, and effective procedure, which provides good functional outcome, high union rate, early pain relief, return to work, and better cosmetic results with minimal complications in indicated cases. LEVEL OF EVIDENCE Level III.