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

Lechler, Philipp; Sturm, Sarah; Boese, Christoph Kolja; Bockmann, Benjamin; Schwarting, Tim; Ruchholtz, Steffen; Lahner, Matthias; Frink, Michael

doi:10.1016/j.injury.2015.11.025

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…In the current study, QuickDASH scores improved marginally after 1 year, and were comparable to previously reported data after long-term followup [10,14,16]. Results of one study indicated that shoulder disability scores reached a steady state 1 year postoperatively [19].…”

Section: Discussionsupporting

confidence: 89%

“…Comparable to the current study, they reported low rates of infection, failure, and nonunion. Therefore, it may be concluded that implant-related irritation is the most frequent complication and seems to be the most frequent reason that necessitated implant removal [2,10,11,14]. At final followup implants were removed more often after IM nailing in our patients.…”

Section: Discussionmentioning

confidence: 60%

“…An explanation for the low major complication rates, like implant failure, could be that in half of the patients (16 in the plate group and 45 in the IM nail group) the implant had been removed before the 1-year followup [21]. Only a few studies have analyzed complications with followup beyond the first year after surgical treatment of displaced midshaft clavicle fractures [2,10,11,14]. Comparable to the current study, they reported low rates of infection, failure, and nonunion.…”

Section: Discussionmentioning

confidence: 99%

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High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Hulsmans

Heijl

Houwert³

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Studies comparing plate with intramedullary nail fixation of displaced midshaft clavicle fractures show faster recovery in the plate group and implant-related complications in both groups after short-term followup (6 or 12 months). Knowledge of disability, complications, and removal rates beyond the first postoperative year will help surgeons in making a decision regarding optimal implant choice. However, comparative studies with followup beyond the first year or two are scarce. Questions/purposes We asked: (1) Does plate fixation or intramedullary nail fixation for displaced midshaft clavicle fractures result in less disability? (2) Which type of fixation, plate or intramedullary, is more frequently associated with implant-related irritation and implant removal? (3) Is plate or intramedullary fixation associated with postoperative complications beyond the first postoperative year?Methods Between January 2011 and August 2012, patients with displaced midshaft clavicle fractures were enrolled and randomized to plate or intramedullary nail fixation. A total of 58 patients with plate and 62 patients with intramedullary nails initially were enrolled. Minimum followup was 30 months (mean, 39 months; range, 30-51 months). Two patients (3%) with plate fixation and two patients (3%) with intramedullary nails were lost to followup. The QuickDASH was obtained at final followup and compared between patients who had plate fixation and those who had intramedullary nail fixation. Postoperative complications measured include infection, implant-related irritation, implant failure, nonunion, and refracture after implant removal. Indications for implant removal included implant-related irritation, implant failure, nonunion, patient's wish, or surgeon's preference. Results Between patients with plate versus intramedullary nail fixation, there were no differences in QuickDASH The institution of one or more of the authors (FJW, RMH, EJV) has received, during the study period, funding from the AO Foundation ((Dübendorf, Switzerland). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Conclusions After a mean followup of 39 months, disability scores were excellent. Major complications did not occur after the 1-year followup. A frequent and bothersome problem after both surgical treatments is implant-related irritation, resulting in high rates of implant removal, after 1 year. Future research could focus on analyzing risk factors for implant irritation or removal. Level of Evidence Level II, therapeutic study.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Hulsmans

Heijl

Houwert³

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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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%

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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“…En el presente estudio la fijación de fracturas con clavos elásticos requirió menor tiempo de cirugía y de hospitalización y además dejo cicatrices más cortas, lo cual coincide con los resultados informados por Lechler et al 23 . En cuanto al resultado funcional, se estableció que fue mejor en los pacientes tratados con clavos elásticos, tal como también lo informaron Duan et al 24 en su estudio.…”

Section: Discussionunclassified

Tratamiento de fracturas del tercio medio de la clavícula con placa versus clavos elásticos intramedulares de titanio

2022

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Introducción. La osteosíntesis con clavos elásticos (fijación intramedular) es un procedimiento que ha venido ganando reconocimiento como una alternativa mínimamente invasiva para el manejo de las fracturas diafisiarias de clavícula (AO/OTA15.2A). Sin embargo, debido a su perfil de complicaciones, la elección del método más adecuado para el manejo primario de las fracturas desplazadas todavía es motivo de controversia. Objetivo. Comparar las tasas de consolidación; los resultados anatómicos, funcionales y estéticos, y las complicaciones en pacientes con fracturas desplazadas del tercio medio de la clavícula intervenidos con clavos elásticos o con placas. Materiales y métodos. Estudio comparativo retrospectivo realizado en 99 pacientes con fracturas desplazadas del tercio medio de la clavicula. Se registraron variables demográficas, tiempo quirúrgico, estancia hospitalaria, complicaciones postoperatorias, longitud de la cicatriz, grado de satisfacción y alteraciones en la sensibilidad de la piel. El resultado funcional se calculó mediante los puntajes Constant y Quick-DASH. Resultados. Se analizaron los resultados de 61 osteosíntesis con clavos elásticos y 38 con placa. En los pacientes intervenidos con clavos elásticos el tiempo de cirugía y el tamaño de la cicatriz fueron menores, mientras que el puntaje Constant, los síntomas irritativos y la prominencia del material fueron mayores. Por su parte, en los pacientes intervenidos con placas la tasa de pseudoartrosis, las alteraciones en la consolidación y la disestesia en la cicatriz fueron mayores. Conclusión. La fijación intramedular para fracturas del tercio medio de la clavícula es una alternativa menos invasiva, con mejores resultados estéticos y funcionales, y con menos complicaciones mayores, en comparacion con la fijación con placa

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

Cited by 7 publications

References 24 publications

High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Functional outcomes and complications of intramedullary fixation devices for Midshaft clavicle fractures: a systematic review and meta-analysis

Tratamiento de fracturas del tercio medio de la clavícula con placa versus clavos elásticos intramedulares de titanio

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