Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases

Abstract

Introduction:Clavicle fractures accounting for 3 to 5% of all adult fractures are usually treated non-operatively. There is an increasing trend toward their surgical fixation. The aim of our study was to investigate the outcome following titanium elastic stable intramedullary nailing (ESIN) for midshaft non-comminuted clavicle fractures with >20 mm shortening/displacement.Materials and Methods:A total of 38 patients, which met inclusion criteria, were reviewed retrospectively. There were 32 males and six females. The mean age was 27.6 years. The patients were assessed for clinical/radiological union and by Oxford Shoulder and QuickDASH scores. 71% patients required open reduction.Results:100% union was achieved at average of 11.3 weeks. The average follow-up was 12 months. The average Oxford Shoulder and QuickDASH scores were 45.6 and 6.7, respectively. 47% patients had nail removal. One patient had lateral nail protrusion while other required its medial trimming.Conclusion:In our hands, ESIN is safe and minimally invasive with good patient satisfaction, cosmetic appearance, and overall outcome.

Surgical complications following ESIN for clavicular mid-shaft fractures do not limit functional or patient-perceived outcome

“…While this finding is in concordance with previous reports [21,22,25], we were not able to reproduce the previously described lower radiation exposure for ESIN [25] as measured by fluoroscopy time or dose area product. This phenomenon could be explained by the relatively high rates of up to 71% intraoperative conversion to open fracture reduction and ESIN insertion by other studies [25,26]. Next, the complication rate of approximately 30% of the present cohort was significantly higher when compared to most of the previously reported studies [10,12,14,23,27].…”

Is there a relationship between the lengths of the ipsilateral clavicle and the ulna? An anthropometric and statistical study

“…Intramedullary nailing is being used successfully to treat fractures of this anatomically complex bone [11] because an intramedullary nail can be inserted with a minimally invasive technique. Closed reduction of the fracture preserves the fracture hematoma and the minimally invasive technique allows the surgeon to minimize soft-tissue dissection, thereby reducing surgical trauma, blood loss, infection, and wound complications [12]. Hill et al [7] showed that the only parameter that affects fracture healing negatively in patients with a mid-shaft clavicle fracture is shortening exceeding 20 mm.…”

“…Intramedullary devices behave as internal splints that maintain alignment without rigid fixation [12]. In a study comparing conservative treatment and intramedullary fixation of displaced non-comminuted fractures, Smekal et al [14] showed that clavicle shortening was significantly less with intramedullary fixation.…”

Intramedullary Screw Fixation of Midshaft Clavicle Fractures

“…They are both stainless-steel intramedullary pins, which are available in multiple diameters. 19 Finally, Smekal and colleagues utilized a titanium elastic nail in the operative arm of a randomized controlled trial comparing operative fixation to nonoperative management of midshaft clavicle fractures. Both are inserted in a similar manner with the only difference being that the Rockwood pin can be inserted either medially or laterally, whereas the Hagie pin can only be inserted laterally because of an additional trocar point on the Rockwood pin.…”