Complications and Technical Pitfalls of Titanium Elastic Nail Fixation for Midclavicular Fractures

Lu, Cheng‐Chang; Liu, Ping Cheng; Huang, Shu‐Mei; Hsieh, Chih Hsin; Tien, Yin-Chun; Chien, Song Hsiung

doi:10.3928/01477447-20140401-60

Cited by 15 publications

(14 citation statements)

References 30 publications

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“…The only difference between the two is that the Rockwood pin also has a trocar point on the machine thread end of the pin. Concerning the Titanium Elastic Nail (TEN) (Depuy Synthes, Warsaw, IN, USA or Stryker, Kalamazoo, MI, USA) the 43 studies that were incorporated in the analysis were comprised of seven level I, [25][26][27][28][29][30][31] eight level II, [32][33][34][35][36][37][38][39] eleven level III [40][41][42][43][44][45][46][47][48][49][50] and seventeen level IV [5,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] studies. 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...…”

Section: Resultsmentioning

confidence: 99%

“…Reports on persistent average shortening after union range between 3.5 and 6.3 mm [27,37,54]. Others report on shortening after union of more > 1 cm in 2.3-50% of cases [41,57,60]. Since shortening of the DMCF can lead to posttraumatic symptoms, altered scapular kinematics and the occurrence of gleno-humeral joint arthritis, shortening is an important issue to prevent and could be interpreted as a disadvantage of this intramedullary fixation device.…”

Section: Discussionmentioning

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%

Section: Discussionmentioning

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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“…Jubel et al [32] documented four cases of migration in their cohort of 65 patients using a titanium elastic nail. Lu et al [33] reported in their study that all of these patients experienced medial nail tip protrusion. In order to remedy these complications, we designed a TEIN based on a titanium elastic nail.…”

Section: Discussionmentioning

confidence: 97%

Minimally invasive fixation of midclavicular fractures with threaded elastic intramedullary nails

Wang

Xiong

et al. 2015

Eur J Orthop Surg Traumatol

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“…However, Lu et al reported that there are significantly displaced clavicle fractures with ESINs treatment. 31 In order to solve these problems, Kaiser et al adopt pre-bending with more than 30° to improve the stability of the nail and also reduce the complications. 32 In addition, the end caps used for elastic stable intramedullary nailing could also reduce the risk of altering construct stability.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive intramedullary nailing of clavicular fractures by a new titanium elastic nail

Fu¹

2016

Acta Orthopaedica et Traumatologica Turcica

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ObjectivesThe aim of this study was to evaluate clinical results of a new design titanium elastic nail (TEN) for displaced midshaft clavicular fractures.Patients and methodsBetween February 2012 and December 2013, a total 36 patients with displaced midshaft clavicular fractures were treated with intramedullary nailing stabilization with our new design TEN. Blood loss, mean times of operation, postoperative complications, hospital stays and time to bone union was recorded. The outcomes were evaluated with radiographic assessment, visual analog scale (VAS) score, the Constant-Murley, and the disabilities of the arm, shoulder, and hand (DASH) scores.ResultsThe mean blood loss was 50.278 ± 10.753 ml, while the mean operation, hospital stay and bone union times were 46.417 ± 9.232 min, 10.056 ± 2.672 days and 11.583 ± 2.729 weeks, respectively. After removal of the TENs at a mean of 10.2 months (range, 8-13 months) after surgery, no re-fracture and nonunion was found in any patient. Two cases of shoulder back stabbing pain were spontaneously resolved later. The mean fracture healing time was 12 weeks. The VAS score and motion ranges of shoulder joint were significantly improved postoperatively (P < 0.001). The shoulder function recovery showed the excellent results with the mean Constant-Murley score of 93.389 ± 2.749 and DASH scores of 2.528 ± 1.567.ConclusionOur new TEN design used in intramedullary fixation might be a safe and effective technique for treatment of displaced midshaft clavicular fractures.Level of evidence: Level IV, therapeutic study.

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Complications and Technical Pitfalls of Titanium Elastic Nail Fixation for Midclavicular Fractures

Cited by 15 publications

References 30 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

Minimally invasive fixation of midclavicular fractures with threaded elastic intramedullary nails

Minimally invasive intramedullary nailing of clavicular fractures by a new titanium elastic nail

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