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Lateral approach for intramedullary nailing of displaced midshaft clavicle fractures; a retrospective cohort study

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Abstract

Purpose

Midshaft clavicle fractures represent about 4% of all fractures in the emergency department. Non-operative treatment of displaced midshaft clavicle fractures (DMCF) can result in a relatively high non-union rate. Several operative techniques, including intramedullary fixation (IMF) using elastic stable intramedullary nailing (ESIN), have therefore been established. IMF through the medial approach is less suitable for fractures of the lateral diaphysis. IMF of DMCF of the lateral diaphysis through a lateral approach can be an alternative approach for these fractures. The aim of this study is to describe the technique of IMF from the lateral side and to present the functional outcome and complications.

Methods

A retrospective cohort study was performed. All patients with a traumatic DMCF treated with IMF using ESIN through a lateral approach between 2014 and 2019 were included. Endpoints were the functional outcome (QuickDASH, Subjective Shoulder Value (SSV)), pain (numeric rating scale (NRS)), daily impairment (activities of daily living (ADL)), complications and implant removal.

Results

Forty out of 43 patients were available for follow-up. Mean follow-up was 37 months. Mean age was 24 years (range 13–70). The median QuickDASH score was 0 (IQR 0.0–0.0) and the median SSV was 100 (95–100). The median ADL score was 1 (1–4) and the median NRS was 0 (0–0). No non-union occurred. Implant related irritation occurred in 11 patients (27.5%). Implants were removed in a total of 38 (95%) patients; in 10 cases due to irritation, in 28 cases routinely or on patient’s request.

Conclusion

IMF of DMCF of the lateral diaphysis through a lateral approach leads to excellent functional results and seems to be a suitable option for internal fixation. However, as with IMF from the medial side, it is not without complications and implant-related irritation.

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Funding

There was no external source of funding for this study.

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Author notes

  1. Nina Kabelitz and Method Kabelitz contributed equally to this manuscript and therefore share first authorship.

Authors and Affiliations

  1. Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland

    Nina Kabelitz, Christoph Sommer & Christian Michelitsch

  2. Department of Orthopaedic Surgery, Spitalregion Rheintal Werdenberg Sarganserland, Spitalstrasse 44, 9472, Grabs, Switzerland

    Method Kabelitz

  3. Department of Trauma Surgery, Noordwest Hospital Group, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Herman Frima

  4. Department of Endocrinology and Diabetes, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany

    Alexandra Rehm

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  1. Nina Kabelitz
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  4. Alexandra Rehm
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  6. Christian Michelitsch
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NK, AR, HF, CS and CM. The first draft of the manuscript was written by NK, MK and CM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nina Kabelitz.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local ethical committee (Kantonale Ethikkommission Zürich, BASEC-Nr. 2020-01044).

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Informed consent was obtained from all individual participants included in the study.

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Kabelitz, N., Kabelitz, M., Frima, H. et al. Lateral approach for intramedullary nailing of displaced midshaft clavicle fractures; a retrospective cohort study. Eur J Trauma Emerg Surg 48, 1263–1270 (2022). https://doi.org/10.1007/s00068-021-01620-4

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  • DOI: https://doi.org/10.1007/s00068-021-01620-4

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