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Can Complications of Titanium Elastic Nailing With End Cap for Clavicular Fractures Be Reduced?

  • Symposium: Fractures of the Shoulder Girdle
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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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Acknowledgment

The authors thank Thomas Perren, MD, for providing cases for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Arno Frigg MD

  2. Department of Trauma Surgery, Davos Hospital, Davos, Switzerland

    Paavo Rillmann MD, Christian Ryf MD, Richard Glaab MD & Lisa Reissner MD

Authors
  1. Arno Frigg MD
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  2. Paavo Rillmann MD
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  3. Christian Ryf MD
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  4. Richard Glaab MD
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  5. Lisa Reissner MD
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Corresponding author

Correspondence to Arno Frigg MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Davos Hospital.

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Frigg, A., Rillmann, P., Ryf, C. et al. Can Complications of Titanium Elastic Nailing With End Cap for Clavicular Fractures Be Reduced?. Clin Orthop Relat Res 469, 3356–3363 (2011). https://doi.org/10.1007/s11999-011-1845-7

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  • DOI: https://doi.org/10.1007/s11999-011-1845-7

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