Surgical Treatment of Midshaft Clavicle Fractures with Intramedullary Titanium Elastic Nailing System

Abstract

Introduction: Fractures of the clavicle are common injuries with an incidence of 5%–10% of all fractures. The most common site of fracture in clavicle is the middle third and accounts for approximately 70%–80% of all clavicle fractures. Clavicle fractures are usually associated with some degree of displacement. Displaced midshaft clavicle fractures can cause significant persistent disability, even if they heal uneventfully when treated conservatively. Surgery is required in case of significant fracture displacement and associated neurovascular injuries. Fractures that require internal fixation are usually treated by plate osteosynthesis as the standard procedure. Intramedullary fixation with titanium elastic nailing system (TENS) is an increasingly popular technique for the internal fixation of displaced mid-clavicular fractures. It is a better fixation device for simple displaced midshaft clavicle fractures. Methodology: A prospective study was conducted with a sample size of 20 patients for 18 months. After obtaining approval and clearance from the institutional ethics committee, the patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. A thorough clinical examination of the patient was done. The diagnosis was made based on X-ray findings. All patients underwent routine preoperative investigations, and their fitness for surgery was taken. The surgery was performed under general or regional anesthesia. Constant–Murley score was used to evaluate the outcome of the study. The cases were followed for a minimum period of 6 months following surgery at the regular intervals of 6, 12, and 24 weeks. Results: The functional outcome in 17 patients was excellent with the union of the fracture site. In one case, there was fixation failure and it had to be converted into plate fixation and was excluded from the study. In four patients, there was hardware prominence at the entry site. Conclusion: TENS is a good internal fixation option for simple displaced midshaft clavicle fractures to reduce the duration of the surgery, decrease the surgical site morbidity, and early mobilization.

Keywords

• clavicle
• intramedullary
• titanium elastic nailing system