Session XII - Upper Extremity
Minimally Invasive Treatment of Displaced Midclavicular Fractures Using a Flexible Titanium Nail
Introduction/Objective: With the development of small flexible nails, the potential for minimally invasive treatment of displaced clavicle fractures offers the potential of stable fixation with less potential for operative complications.
Methods: Over an 8-year period, intramedullary osteosynthesis was performed on 132 patients with 136 displaced middiaphyseal OTA type A and B clavicle fractures. 89 patients were male and 43 female with an average age of 32.9 years (range, 13-74). The surgery was performed at an average of 8 days after injury. 78 fractures could be reduced closed and the nail placed from medial to lateral percutaneously, while in 58 an additional 1- to 2-cm incision over the fracture was required. For the majority of fractures, a 3-mm titanium nail was used. The average duration of fluoroscopy was 2.9 min.
Results: For those patients with an isolated clavicle fracture, the level of pain using a VAS scale of 0-100 was measured before surgery and on day 3 postoperatively. The preoperative pain averaged 72.4 points while on day 3 the level dropped to 18.9 points. Transient paresthesias extending down the arm was noted in 3 patients, which resolved rapidly. The nail was routinely removed an average of 7.6 months postop. All fractures but one in a polytrauma patient had healed. The one nonunion was treated at another hospital with a plate. 106 patients could be directly followed 12 months after implant removal using the Constant-Murley outcome tool, which has been validated. The average score was 97.1 points (maximum 100 pts). Full shoulder mobility was found in all without evidence of neurologic problem. In 3 patients with a comminuted fracture, shortening of the clavicle of 1.5 ± 0.5cm was noted. Among the 132 patients were 12 top performance or professional athletes with an average age of 24.8 yrs. After surgery, 12 returned to training on average 6 days and active sport on average 17 days postop. At final follow-up, the Constant-Murley score averaged 98.3 pts.
Conclusion: With a greater recognition of the beneficial effects of operative treatment of displaced midclavicle fractures, the use of a minimally invasive technique is appealing and may well enhance outcome and limit potential operative morbidity.