Skip to main content

Advertisement

SpringerLink
Log in

Titanium elastic nails, open reduction internal fixation and non-operative management for middle third clavicle fractures: a comparative study

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objectives

To compare clinical outcomes between titanium elastic nails (TENS), open reduction internal fixation (ORIF) and non-operative treatment options at mean 30 months in Allman type 1 fractures of the clavicle.

Design

Retrospective case matched.

Setting

Tertiary Trauma Centre, UK.

Patients

Treatment method was based on surgeon choice although there was no difference between groups in terms of age or gender. Those treated non-operatively tended to have a less severe fracture pattern. There were 25 patients treated with TENS, 24 with ORIF and 41 treated conservatively.

Main outcome measurements are qDASH questionnaire, patient satisfaction question and clinical complication rate.

Results

Patients managed with TENS had significantly better clinical outcomes than both plate fixation and non-operatively managed groups.

Conclusions

This study supports the use of TENS fixation of middle third clavicle fractures in significantly displaced Allman type 1 injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Wick M, Müller EJ, Kollig E, Muhr G (2001) Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg 121:207–211

    Article  CAS  PubMed  Google Scholar 

  2. Stanley D, Trowbridge S, Norris SH (1998) The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg 70:461–464

    Google Scholar 

  3. Allman F (1967) Fractures and clavicle ligamentous injuries of the its articulation. J Bone Joint Surg 49:774–784

    PubMed  Google Scholar 

  4. Andersen K, Jensen P, Lauritzen J (1987) Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthopaedica 58:71–74

    Article  CAS  Google Scholar 

  5. Vanbeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN (2011) Precontoured plating of clavicle fractures: decreased hardware-related complications? Clin Orthop Relat Res 469:3337–3343

    Article  PubMed Central  PubMed  Google Scholar 

  6. COTS (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89:1–10

    Google Scholar 

  7. Cho C-H, Song K-S, Min B-W, Bae K-C, Lee K-J (2010) Operative treatment of clavicle midshaft fractures: comparison between reconstruction plate and reconstruction locking compression plate. Clin Orthop Surg 2:154–159

    Article  PubMed Central  PubMed  Google Scholar 

  8. Lee Y-S, Huang H-L, Lo T-Y, Hsieh Y-F, Huang C-R (2008) Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation. Int Orthop 32:541–545

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Simon P (2010) Mid-clavicle fractures in adults: surgery or not? Eur J Orthop Surg Traumatol 20:521–525

    Article  Google Scholar 

  10. Mueller M, Rangger C, Striepens N, Burger C (2008) Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails. J Trauma 64:1528–1534

    Article  CAS  PubMed  Google Scholar 

  11. Rehm KE, Andermahr J, Jubel A (2005) Intramedullary nailing of midclavicular fractures with an elastic titanium nail. Eur J Trauma 31:409–416

    Article  Google Scholar 

  12. 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

    Article  PubMed Central  PubMed  Google Scholar 

  13. Liu P-C, Chien S-H, Chen J-C, Hsieh C-H, Chou P-H, Lu C–C (2010) Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma 24:217–223

    Article  CAS  PubMed  Google Scholar 

  14. Frigg A, Rillmann P, Perren T, Gerber M, Ryf C (2009) Intramedullary nailing of clavicular midshaft fractures with the titanium elastic nail: problems and complications. Am J Sports Med 37:352–359

    Article  PubMed  Google Scholar 

  15. Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11

    Article  PubMed Central  PubMed  Google Scholar 

  16. Schemitsch LA, Schemitsch EH, Veillette C, Zdero R, McKee MD (2011) Function plateaus by one year in patients with surgically treated displaced midshaft clavicle fractures. Clin Orthop Relat Res 469:3351–3355

    Article  PubMed Central  PubMed  Google Scholar 

  17. Siehl D, Bradford W (1953) Intramedullary pinning of the clavicle. J Am Osteopathy Assoc 53:243–245

    CAS  Google Scholar 

  18. Buda D, Peria G (1958) Treatment of fractures of the clavicle with intramedullary axial wiring; consideration of 112 cases. G Ital Chir 14:900–914

    CAS  PubMed  Google Scholar 

  19. Paffen P, Jansen E (1978) Surgical treatment of clavicular fractures with Kirschner wires: a comparative study. Arch Chir Neerl 30:43–53

    CAS  PubMed  Google Scholar 

  20. Jubel A, Andermahr J, Bergmann H, Prokop A, Rehm K (2003) Elastic stable intramedullary nailing of midclavicular fractures in athletes. Br J Sports Med 37:480–485

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Kettler M, Schieker M, Braunstein V, König M, Mutschler W (2007) Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: technique and results in 87 patients. Acta Orthopaedica 78:424–429

    Article  PubMed  Google Scholar 

  22. Tarng Y-W, Yang S-W, Fang Y-P, Hsu C-J (2012) Surgical management of uncomplicated midshaft clavicle fractures: a comparison between titanium elastic nails and small reconstruction plates. J Shoulder Elbow Surg 21(6):732–740

    Article  PubMed  Google Scholar 

  23. Chen Y-F, Wei H-F, Zhang C, Zeng B-F, Zhang C-Q, Xue J-F, Xie X-T, Lu Y (2012) Retrospective comparison of titanium elastic nail (TEN) and reconstruction plate repair of displaced midshaft clavicular fractures. J Shoulder Elbow Surg 21(4):495–501

    Article  PubMed  Google Scholar 

  24. Assobhi JEH (2011) Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol 12:185–192

    Article  PubMed Central  PubMed  Google Scholar 

  25. 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 Elbow Surg 20:1008–1015

    Article  PubMed  Google Scholar 

  26. Houwert RM, Wijdicks F-J, Steins Bisschop C, Verleisdonk E-J, Kruyt M (2012) Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 36(3):579–585

    Article  PubMed Central  PubMed  Google Scholar 

  27. Lenza M, Belloti J, Gomes dos Santos JM, Matsumoto M, Faloppa F (2009) Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev (4): CD007428

  28. Davies D, Longworth A, Amirfeyz R, Fox R, Bannister G (2009) The functional outcome of the fractured clavicle. Arch Orthop Trauma Surg 129:1557–1564

    Article  PubMed  Google Scholar 

  29. O’Neill BJ, Hirpara KM, O’Briain D, McGarr C, Kaar TK (2011) Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. Int Orthop 35:909–914

    Article  PubMed Central  PubMed  Google Scholar 

  30. Haywood KL (2006) Patient-reported outcome I: measuring what matters in musculoskeletal care. Musculoskelet Care 4:187–203

    Article  Google Scholar 

Download references

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Oxford, UK

    Luke D. Jones & George Grammatopoulos

  2. John Radcliffe Hospital, Oxford, UK

    Gregoris Kambouroglou

Authors
  1. Luke D. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Grammatopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregoris Kambouroglou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luke D. Jones.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jones, L.D., Grammatopoulos, G. & Kambouroglou, G. Titanium elastic nails, open reduction internal fixation and non-operative management for middle third clavicle fractures: a comparative study. Eur J Orthop Surg Traumatol 24, 323–329 (2014). https://doi.org/10.1007/s00590-013-1191-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1191-4

Keywords

Search

Navigation