Zdravniški Vestnik (Jun 2005)
Fixation of the midclavicular fractures with the titanium elastic nails in adults – preliminary results
Abstract
Background: Elastic intramedullary fixation is an established operative treatment for fractures in childhood, which is only exceptionally used in adults. A modified intramedullary fixation of midclavicular fractures in adults with titanium elastic nails is presented.Methods: The group was comprised of five adult patients with shortened midclavicular fractures. The prior conservative treatment had been ineffective in three cases, whereas poor functional outcome was expected in the other two, as a result of fracture shortening or instability. According to the new technique titanium elastic nails were first placed into the intramedullar channel of the distal fragment through the fracture, using a mini-open exposure. The nails were advanced retrogradely into the proximal fragment to achieve a stable fixation. The initial post-operative rehabilitation included pendulary exercises in a sling. Active exercises in the range of pain allowance were introduced after the operative wounds had been healed.Results: All fractures were consolidated in the physiological position. The patients were capable of painless movements with the shoulder on the operated side in the full range of motion after six weeks. One transitory complication in the form of skin and subcutaneous decubitus over the protruded nail tip was noted without an influence on the end result.Conclusions: The preliminary results in a limited number of patients showed efficient consolidation of the midclavicular fractures in adults treated with intramedullar titanium elastic nails. The functional results and low invasivity of the procedure support its further use in treatment of midclavicular fractures, which fail to heal conservatively, or which are expected to result in poor functional or cosmetic outcome.
