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Year : 2016  |  Volume : 51  |  Issue : 2  |  Page : 147-153

Limited open reduction and elastic intramedullary nailing for mid-shaft clavicular fractures

Department of Trauma and Orthopaedic Surgery, Mansoura University, Mansoura, Egypt

Correspondence Address:
Prof. Dr. Adham Elgeidi
PO Box 95 Mansoura University, Mansoura 35516
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-1148.203149

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Background Elastic intramedullary nailing (EIN) of displaced mid-shaft clavicular fractures is a minimally invasive technique, which was reported to be a simple procedure with low complication rate and good functional results. Other studies, however, report on specific problems with this technique. This prospective study reports on EIN in displaced mid-shaft clavicular fracture. We hypothesized that restoration of clavicular length is the primary goal of EIN. Patients and methods Between January 2008 and January 2012, 36 patients with simple, wedge or comminuted mid-shaft clavicular fractures were treated with EIN. Clavicular shortening was determined after trauma and after osseous consolidation on true clavicle anteroposterior radiograph with a 20° cephalic tilt with the patient in a standing position. Radiographic union was assessed every 4 weeks. Patient satisfaction was assessed at final follow-up after 1 year. Results Among the 36 patients, 34 fractures healed, and each underwent a planned procedure for nail removal. Complications included two nonunions, one delayed union, two nail migrations and one deep-wound infection. EIN led to restoration of clavicular length in simple and wedge fractures. We were not able to restore length in comminuted fractures through the EIN technique. Patient satisfaction at a mean follow-up of 29.5 months was significantly correlated with the lesser post-traumatic and posthealing shortening, quicker fracture healing and early implant removal. Conclusion Intramedullary nail fixation for acute simple or wedge-type mid-shaft clavicular fractures provides a safe and predictable treatment option. In comminuted fractures, however, EIN does not provide the needed stability to restore clavicular length.

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