Abstract
Purpose
To reveal whether minimal invasive implantation of a novel intramedullary device produces comparable outcomes with LCP fixation in patients with displaced midshaft clavicle fractures.
Methods
A prospective randomized two-arm study was performed on patients presenting with Robinson type 2B1 and 2B2 displaced midshaft clavicle fractures with >2 cm shortening. In group 1 (n = 35, mean age; 42.02 ± 13.87) patients received minimal invasive intramedullary fixation with Sonoma Crx device (Sonoma, USA) whereas in group 2 (n = 40, mean age; 39.07 ± 7.04) patients received 3.5 mm locking compression plate (Synthes, USA). Functional assessment was made using range of motion measurement (ROM), constant shoulder score and DASH disability of the arm, shoulder and hand (DASH) scoring.
Results
Mean time of operation was similar between the two groups (p = 0.46) whereas mean time of fluoroscopy was significantly longer in group 1 compared to group 2 (p < 0.001). At the 12 month follow-up, there was a slight but significant difference in ROM degrees between the two groups (p = 0.005). Mean quick DASH score was significantly lower in group 1 than that in group 2 (p < 0.001) whereas there was no significant difference in constant shoulder scores between the two groups (p = 0.06). Time to bony union was also shorter in group 1 compared to group 2 (p < 0.001).
Conclusion
Minimal invasive intramedullary implantation technique provided satisfactory clinical outcomes and shortened the time until bony union compared to LCP fixation. Further study on larger populations is required to establish whether the technique offers lower complication rates than LCP fixation.
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References
Jørgensen A, Troelsen A, Ban I (2014) Predictors associated with nonunion and symptomatic malunion following non-operative treatment of displaced midshaft clavicle fractures—a systematic review of the literature. Int Orthop 38:2543–2549
Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F (2013) Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev 6:CD009363
Ranalletta M, Rossi LA, Piuzzi NS, Bertona A, Bongiovanni SL, Maignon G (2014) Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes. Am J Sports Med doi: 10.1177/0363546513501494
Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO et al (2013) Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am 95:1576–1584
van der Meijden OA, Gaskill TR, Millett PJ (2012) Treatment of clavicle fractures: current concepts review. J Shoulder Elb Surg 21:423–429
Will R, Englund R, Lubahn J, Cooney TE (2011) Locking plates have increased torsional stiffness compared to standard plates in a segmental defect model of clavicle fracture. Arch Orthop Trauma Surg 131:841–847
Golish SR, Oliviero JA, Francke EI, Miller MD (2008) A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res 3:28
King PR, Ikram A, Lamberts RP (2014) The treatment of clavicular shaft fractures with an innovative locked intramedullary device. J Shoulder Elb Surg 17
Beaton DE, Wright JG, Katz JN (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87:1038–1046
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Assobhi JE (2011) Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol 12:185–192
Richardson M, Asadollahi S, Richardson L (2013) Management of acute displaced midshaft clavicular fractures using Herbert cannulated screw: technique and results in 114 patients. Int J Shoulder Surg 7:52–58
Wu CL, Chang HC, Lu KH (2013) Risk factors for nonunion in 337 displaced midshaft clavicular fractures treated with Knowles pin fixation. Arch Orthop Trauma Surg 133:15–22
Mudd CD, Quigley KJ, Gross LB (2011) Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood Clavicle Pin. Clin Orthop Relat Res 469:3364–3370
Narsaria N, Singh AK, Arun GR, Seth RR (2014) Surgical fixation of displaced midshaft clavicle fractures: elastic intramedullary nailing versus precontoured plating. J Orthop Traumatol 25
Wijdicks FJ, Houwert RM, Millett PJ, Verleisdonk EJ, Van der Meijden OA (2013) Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Can J Surg 56:58–64
King R, Ikram A (2013) Intramedullary locked fixation of clavicle shaft fractures–review of early results. Bone Joint J Orthop Proc Suppl 95:71
Wilson DJ, Weaver DL, Balog TP, Arrington ED (2013) Early postoperative failure of a new intramedullary fixation device for midshaft clavicle fractures. Orthopedics 36:1450–1453
Palmer DK, Husain A, Phipatanakul WP, Wongworawat MD (2011) Failure of a new intramedullary device in fixation of clavicle fractures: a report of two cases and review of the literature. J Shoulder Elb Surg 20:1–4
Jiang H, Qu W (2012) Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res 98:666–671
Duan X, Zhong G, Cen S, Huang F, Xiang Z (2011) Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elb Surg 20:1008–1015
Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M (2012) Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 36:579–585
Barlow T, Beazley J, Barlow D (2013) A systematic review of plate versus intramedullary fixation in the treatment of midshaft clavicle fractures. Scott Med J 58:163–167
Zhu Y, Tian Y, Dong T, Chen W, Zhang F, Zhang Y (2015) Management of the mid-shaft clavicle fractures using plate fixation versus intramedullary fixation: an updated meta-analysis. Int Orthop 39:319–328
Zhou Y, Li XY, Li H, Xiao T (2015) Letter regarding article by Zhu et al: management of the mid-shaft clavicle fractures using plate fixation versus intramedullary fixation: an updated meta-analysis. Int Orthop 39:2521–2522
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Calbiyik, M., Ipek, D. & Taskoparan, M. Prospective randomized study comparing results of fixation for clavicular shaft fractures with intramedullary nail or locking compression plate. International Orthopaedics (SICOT) 41, 173–179 (2017). https://doi.org/10.1007/s00264-016-3192-5
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DOI: https://doi.org/10.1007/s00264-016-3192-5