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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

We report our initial experiences with use of a new technique we developed for implantation of Sonoma Crx intramedullary rod in patients with displaced clavicle fractures.

Methods

A total of 35 patients (mean age 41.82 ± 13.65, male:female ratio = 21:14) having Robinson Types 1b, 2b and 3b displaced midshaft fractures with >2 cm clavicle shortening were included into the study. A single small incision (~1 cm) was made over the anteromedial aspect of the involved clavicle and an appropriate sized intramedullary nail was inserted in reverse (mirror) configuration of that has been suggested by the manufacturer. Functional assessment was made using Constant shoulder and disability of the arm shoulder and hand scoring.

Results

Mean time of operation was 51.20 ± 10.56 min and mean time of fluoroscopy was 2.33 ± 1.12 min. One patient had implant failure 2 months after the operation and was revised to a new implant. Superficial or deep wound infection, hematoma, neurovascular complication, substance irritation or implant failure did not occur. Follow-up ranged from 12 to 45 months (mean 28.5 ± 9.95 months). At the latest follow-up, mean Constant shoulder score was 93.14 ± 4.06 (ranging from 84.00 to 100.00) and mean disability of the arm shoulder and hand score was 3.68 ± 1.73 (ranging from 0.0 to 6.80).

Conclusion

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.

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References

  1. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31:350–8.

    Article  Google Scholar 

  2. Van Tassel D, Owens BD, Pointer L. Moriatis Wolf J. Incidence of clavicle fractures in sports: analysis of the NEISS Database. Int J Sports Med. 2014;35:83–6.

    PubMed  Google Scholar 

  3. van Laarhoven JJ, Ferree S, Houwert RM, Hietbrink F, Verleisdonk EM, Leenen LP. Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study. World J Emerg Surg. 2013;8:36.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11:452–6.

    Article  PubMed  Google Scholar 

  5. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91:447–60.

    Article  PubMed  Google Scholar 

  6. Riehl JT, Athans BJ, Munro MW, Langford JR, Kupiszewski SJ, Haidukewych GJ, et al. Minimally displaced clavicle fracture after high-energy injury: are they likely to displace? Can J Surg. 2014;57:169–74.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Liu GD, Tong SL, Ou S, Zhou LS, Fei J, Nan GX, Gu JW. Operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop. 2013;37:1495–500.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Virtanen KJ, Malmivaara AO, Remes VM, Paavola MP. Operative and nonoperative treatment of clavicle fractures in adults. Acta Orthop. 2012;83:65–73.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee YS, Lau MJ, Tseng YC, Chen WC, Kao HY, Wei JD. Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle. Int Orthop. 2009;33:1401–5.

    Article  PubMed  Google Scholar 

  10. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80:476–84.

    Article  CAS  PubMed  Google Scholar 

  11. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol. 2011;12:185–92.

    Article  PubMed  PubMed Central  Google Scholar 

  12. King PR, Ikram A. Lamberts RP The treatment of clavicular shaft fractures with an innovative locked intramedullary device. J Shoulder Elbow Surg. 2014;17:e1–6.

    Google Scholar 

  13. Richardson M, Asadollahi S, Richardson L. Management of acute displaced midshaft clavicular fractures using Herbert cannulated screw: technique and results in 114 patients. Int J Shoulder Surg. 2013;7:52–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wu CL, Chang HC, Lu KH. Risk factors for nonunion in 337 displaced midshaft clavicular fractures treated with Knowles pin fixation. Arch Orthop Trauma Surg. 2013;133:15–22.

    Article  PubMed  Google Scholar 

  15. Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:280–4.

    Article  PubMed  Google Scholar 

  16. Mudd CD, Quigley KJ. Gross LB. Clin Orthop Relat Res. 2011;469:3364–70.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Narsaria N, Singh AK, Arun GR, Seth RR. Surgical fixation of displaced midshaft clavicle fractures: elastic intramedullary nailing versus precontoured plating. J Orthop Traumatol. 2014;25:165–71.

    Article  Google Scholar 

  18. Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res. 2003;408:279–85.

    Article  Google Scholar 

  19. Lu CC, Liu PC, Huang SH, Hsieh CH, Tien YC, Chien SH. Complications and technical pitfalls of titanium elastic nail fixation for midclavicular fractures. Orthopedics. 2014;37:e377–83.

    Article  PubMed  Google Scholar 

  20. King R, Ikram A. Intramedullary locked fixation of clavicle shaft fractures-review of early results. Bone Joint J Orthopaedic Proc Suppl. 2013;95:71–71.

    Google Scholar 

  21. Wilson DJ, Weaver DL, Balog TP. Arrington ED Early postoperative failure of a new intramedullary fixation device for midshaft clavicle fractures. Orthopedics. 2013;36:1450–3.

    Article  Google Scholar 

  22. Palmer DK, Husain A, Phipatanakul WP, Wongworawat MD. Failure of a new intramedullary device in fixation of clavicle fractures: a report of two cases and review of the literature. J Shoulder Elbow Surg. 2011;20:1–4.

    Article  Google Scholar 

  23. Payne DE, Wray WH, Ruch DS, Zura RD, Moorman CT. Outcome of intramedullary fixation of clavicular fractures. Am J Orthop (Belle Mead NJ]. 2011;40:E99–104.

    PubMed  Google Scholar 

  24. King PR, Scheepers S, Ikram A. Anatomy of the clavicle and its medullary canal: a computed tomography study. Eur J Orthop Surg Traumatol. 2014;24:37–42.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Hitit University Corum Education and Research Hospital, Camlik St No. 2, Corum, Turkey

    M. Calbiyik, S. Zehir & D. Ipek

Authors
  1. M. Calbiyik
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  2. S. Zehir
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  3. D. Ipek
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Correspondence to M. Calbiyik.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Murat Calbiyik, Sinan Zehir and Deniz Ipek declare that they have no conflict of interest.

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Calbiyik, M., Zehir, S. & Ipek, D. Minimally invasive implantation of a novel flexible intramedullary nail in patients with displaced midshaft clavicle fractures. Eur J Trauma Emerg Surg 42, 711–717 (2016). https://doi.org/10.1007/s00068-015-0567-z

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  • DOI: https://doi.org/10.1007/s00068-015-0567-z

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