Elastic Intramedullary Nail Fixation of Displaced Midshaft Clavicular Fractures

Abstract Background: Undisplaced midclavicular fractures are generally managed conservatively. Imminent perforation of the skin, impending or existing neurovascular compromise and the floating shoulder represent absolute indications for operative treatment. Gross displacement of fracture fragments, as well as non-unions, are seen as relative indications for surgical fixation. Plate osteosynthesis is the standard operative treatment, but higher complication rates have been described with this technique. Aim of Study: The aim of this work was to study the short term results of treatment of displaced fractures of the middle third of the clavicle using percutaneous elastic intramedullary nails. Patients and Methods: This study was a prospective case series carried out on twenty patients with displaced fractures of the middle third of the clavicle presented to Tanta University Hospital from September 2016 to January 2018 and treated by percutaneous elastic intramedullary nails. Results: In this study 20 patients were included with a mean age of 26.40±8.91 years, 17 patients (85%) were males and 3 patients (15%) were females. Three patients (15%) had associated medical conditions. The time lapse before surgery in the studied patients ranged from 1 day to 10 days with a mean 4.60±2.93 day. Open reduction was done in 6 cases (30%) out of 20 cases after failed closed reduction of fracture. Time of union in the studied patients ranged from 8 weeks to 12 weeks with a mean 10.0±1.33 weeks with an exception of one case which presented with hypertrophic non-union. Time of union in the studied patients ranged from 8 weeks to 12 weeks with a mean 10.0±1.33 weeks with an exception of one patient which presented with hypertrophic non-union. The final Constant score was 95.70±13.55. Excellent results in fourteen patients (70%), good in four (20%), fair in one (5%), and poor in one (5%). Pain was moderate in one patient (5%), while 19 (95%) reported absence of pain. Time of union ranged from 8 weeks to 12 weeks with a mean 10.0±1.33 weeks with an exception of one case which, presented with hypertrophic non-union. Complications encountered were infection in one patient (5%), medial skin irritation in two (10%), dorsolateral migration in two (10%) and hypertrophic non-union in one patient (5%). Conclusions: Elastic stable intramedullary nailing (ESIN) is an image dependant procedure indicated best for young medically free patients with acute simple 2 part middle third clavicle fracture. Main advantage of this technique is providing a more rapid free movement of the shoulder and an earlier return to daily activities than the conservative treatment. In comparison with plate fixation, the procedure is less invasive, no loss of fracture haematoma, rapid union, and less infection. No major surgery for removal with less injury to surrounded neurovascular structures. Smaller incision is required with superior cosmesis. There was statistically significant relation-ship between the final score and the patients’ age and associated medical conditions.