| Can complications of titanium elastic nailing with end cap for clavicular fractures be reduced? | |
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MedLine Citation:
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PMID: 21409459 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We found treatment of clavicular midshaft fractures using titanium elastic nails (TENs) in combination with postoperative free ROM was associated with a complication rate of 78%. The use of end caps reduced the rate to 60%, which we still considered unacceptably high. Thus, we explored an alternative approach. QUESTIONS/PURPOSES: We investigated whether (1) the complication rate could be reduced by cautious lateral advancement of the TENs, intraoperative oblique radiographs to rule out lateral perforation, and limited ROM postoperatively; (2) fluoroscopy time could be reduced; and (3) shoulder function would be reasonable. PATIENTS AND METHODS: From March 2006 to December 2009, we treated 44 patients with midshaft clavicular fractures with TENs and end caps. In the first group (n = 15), the TEN was advanced laterally using an oscillating drill. The patients were permitted free ROM. In the second group (n = 29), the TEN was advanced by hand, conversion to open reduction followed two failed closed attempts and lateral perforation was checked with an intraoperative oblique radiograph. Furthermore, anteversion and abduction of the shoulder were limited to 90° for the first 6 weeks. Minimum followup was 12 months (mean, 16.7 months; range, 12-28 months). RESULTS: The total complication rate was reduced from nine of 15 in the first group to five of 29 in the second group. Medial perforations ceased with the use of the end cap. Fluoroscopy time was reduced from a mean of 10 to 4 minutes by converting to open reduction after two failed closed attempts. All but three patients exhibited full shoulder ROM at three months and these three had a slight deficit of 10° to 20° in anteversion and/or abduction. At last followup, the mean American Shoulder and Elbow Surgeons score was 92 (range, 88-100) and the Disability of the Arm, Shoulder, and Hand score 1.4 (range, 0-12.5). CONCLUSIONS: Cautious insertion of the TENs, intraoperative oblique radiographs, and limiting the ROM for 6 weeks postoperatively reduced the complication rate. Using TENs with end caps for midshaft clavicular fractures is minimally invasive while associated with comparable complication rates and function to plate osteosynthesis. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. |
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Authors:
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Arno Frigg; Paavo Rillmann; Christian Ryf; Richard Glaab; Lisa Reissner |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Clinical orthopaedics and related research Volume: 469 ISSN: 1528-1132 ISO Abbreviation: Clin. Orthop. Relat. Res. Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-11-08 Completed Date: 2012-08-17 Revised Date: 2013-02-19 |
Medline Journal Info:
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Nlm Unique ID: 0075674 Medline TA: Clin Orthop Relat Res Country: United States |
Other Details:
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Languages: eng Pagination: 3356-63 Citation Subset: AIM; IM |
Affiliation:
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Department of Orthopedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. mail@arnofrigg.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Case-Control Studies Clavicle / injuries* Equipment Design Female Fluoroscopy Fracture Fixation, Intramedullary / adverse effects*, methods Fractures, Bone / surgery* Humans Length of Stay Male Postoperative Complications / epidemiology, prevention & control Range of Motion, Articular Shoulder Joint / physiopathology Titanium Young Adult |
| Chemical | |
Reg. No./Substance:
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7440-32-6/Titanium |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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