Elastic-Stable Intramedullary Nailing of Midclavicular Fractures in Adults: A Novel Treatment Option

Abstract

BACKGROUND:This prospective consecutive case series was done to evaluate indications, technical pearls and pitfalls and functional outcomes of elastic stable intramedullary nailing of displaced mid clavicular fractures and the effectiveness of the titanium elastic stable intramedullary nails in the surgical treatment of the mid clavicular fractures in adults. MATERIALS & METHODS: A total of 80 patients (60 men, 20 female) were included in this study. Constant score and radiographs were evaluated after 1 and 6 weeks, 3 months and 6 months in 80 patients. Mean age was 28 years. RESULTS: Length of incision, operation time, blood loss and duration of hospital stay were significantly less. The average follow-up was 17 months. Mean operation time was 62 minutes. Open reduction through an additional small incision was necessary for some fractures. Mean hospital stay was 1.2 days. The Constant score averaged 81 after 1 week, 96 after 6 weeks and 98 after 6 months. Compared to the contralateral side, average shortening of the clavicle was 1.7 mm. CONCLUSION: Elastic Intramedullary Nailing provided a good restoration of the length of the clavicle allowing immediate active mobilization and early return to normal activity with excellent functional results. KEYWORDS: Clavicle fractures; Intra medullary nailing; elastic stable intramedullary nails. INTRODUCTION:Fracture of the clavicle is a frequently seen injury which represents about 10-15% of all fractures in adults. (1) In most cases a fall with a direct trauma causes the clavicle to fracture. About 80% of all clavicular fractures involve the middle third of the bone. (2) Standard treatment for this fracture pattern is non-operative, using an arm sling or figure-ofeight bandage for external fixation. For open fractures, imminent skin perforation, neurovascular involvement, floating shoulder or in combination with multiple ipsilateral rib fractures, open reduction and plating is generally accepted. (3) While fracture healing and functional outcome is generally good for non-operatively treated mid clavicular fractures, a poor cosmetic result due to shortening and angulation is not uncommon. (2) Non-unions occur in an average of 5%. (3) Furthermore decreased shoulder function due to clavicular shortening of more than 1-2 cm after non-operative fracture management has been reported. (5,12) Whereas a mild decrease in shoulder function is easily tolerated by most patients, restoration of the clavicle length and early return to full activity with unimpaired function is of great importance for every individual irrespective of the profession or socio-economic group they belong to.As non-operative treatment is successful in most cases for this fracture, relevant clinical benefit may be limited to a selected group of patients with a high demand on shoulder function.