Clinical effect of Nice knot-assisted minimally invasive titanium elastic nail fixation in the treatment of Robinson 2B midshaft clavicular fracture

Abstract

Background The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but there are no reports on its use in complex fractures. The aim of this study was to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures.Methods A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function, Disability of Arm Shoulder and Hand (DASH) score, complications, and second surgical incision length were recorded.Results The length of the incision was 2–6 cm (mean, 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92–100 (mean, 96) and the DASH score was 0-6.2 (mean, 2.64). ESIN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four (13.8%) after operation. Internal fixators were removed at 12–26 months (mean, 14.6 months) after operation, and the length of the second incision was 1-2.5 cm (mean, 1.3 cm).Conclusions Intramedullary clavicle fixation with TEN is an ideal surgical technique. Nice knot-assisted fixation effectively stabilizes multifragmentary fractures, thereby achieving fracture healing. Surgeons should consider this technique in cases of Robinson 2B midshaft clavicular fractures.Trial registration: Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People's Hospital (LW20220021).