Minimally invasive implantation of a novel flexible intramedullary nail in patients with displaced midshaft clavicle fractures

Çalbıyık, Murat; Zehir, Sinan; İpek, Deniz

doi:10.1007/s00068-015-0567-z

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…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] one level III [71] and one level IV…”

Section: Resultsmentioning

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%

“…Two studies reported on persistent pain as a complication [68,71] and 1 study mentions the occurrence of a delayed union [67].…”

Section: Studies Concerning the Sonoma Crx Meta-analysismentioning

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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“…Subsequent selection procedure resulted in 63 eligible articles of which 58 studies could be included in this systematic review and 53 in the metaanalysis ( Fig. 1) [57,58] one level II, [59] one level III [60] and one level IV [61]) were identified. Less frequently described intramedullary fixation devices were the threaded titanium elastic nails (Kang Li Min Medical Devices Co. Ltd., Tianjin, China), [62][63][64] the Knowles pin (Zimmer Biomet, Warshaw, IN, USA) [65][66][67][68] and one study describing a second generation Titanium elastic nail (Puwei Medical Appliances Inc, Shanghai, China).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported on persistent pain as a complication [58,60] and 1 study mentions the occurrence of a delayed union. [57] Studies concerning a threaded elastic nail Meta-analysis was only possible for infection [62][63][64] and the pooled incidence was 5% (95%CI 1-34).…”

Section: Meta-analysismentioning

confidence: 99%

Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

Hoogervorst¹,

Dam²,

Hannink³

2019

Preprint

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Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures using plate osteosynthesis, is internal fixation by means of an intramedullary fixation device. These devices differ considerably in their specifications and characteristics and an adequate evaluation of their clinical results is warranted. 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 were searched from inception until January 2018. 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. Results Fifty-eight 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 94.2 (96%CI 93.2-95.3) and 93.4 (95%CI 92.1-94.7) respectively. 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 of 20% (95%CI 14-27) and 13% (95%CI 9-20), are major contributors to the total complication rate. For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 21% (95%CI 11-35). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 7% (95%CI 2-22) of cases. Conclusion Although most studies were of low quality, in general, good functional results and union rates irrespective of the type of device are found in the reviewed literature. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

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“…It is still unclear whether intramedullary fixation or plate fixation is better for treating mid-shaft clavicle fracture, and further appropriately designed studies are needed to differentiate the clinical outcomes. [ 40 41 ] At present, the application of plate fixation in antero-inferior fractures can achieve good mechanical properties, and reduce complications. The locking compression plate can also be used for open clavicle fractures.…”

Section: Onclusionsmentioning

confidence: 99%

The Treatment of Mid-shaft Clavicle Fractures

Sang

Gou²,

Zheng

et al. 2015

Chinese Medical Journal

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Objective:Through reviewing the relevant literature from the past decades, to summarize the assessment and management of fractures of the clavicle, and provide an overview of the clinical results of a range of treatment options.Data Sources:The data analyzed in this review are mainly from articles included in PubMed and EMBASE, published from 1960 to 2015.Study Selection:Studies involving assessment of fractures of the clavicle were reviewed. Further literatures were gathered regarding the conservative and surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.Results:Through retrieving and reading the abstract, a total of 42 representative articles were selected, which covered all aspects of the conservative treatment and surgical treatment, and compared the advantages and disadvantages of different treatment options.Conclusions:Although the majority of recent data suggest that surgery may be more appropriate as it improves functional outcome and reduces the risk of complications, we recommend that the treatment should be individually assessed.

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Minimally invasive implantation of a novel flexible intramedullary nail in patients with displaced midshaft clavicle fractures

Abstract: The technique we described herein provided successful procedural outcomes, eliminated the need for deep dissection of the fracture site and reduced the operation time. Further study on larger populations is warranted to confirm these findings.

Cited by 11 publications

References 23 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

Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

The Treatment of Mid-shaft Clavicle Fractures

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