Limits...
Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures: A comparative study.

Saha P, Datta P, Ayan S, Garg AK, Bandyopadhyay U, Kundu S - Indian J Orthop (2014)

Bottom Line: Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications.During analysis, we had 37 patients in the plate group and 34 patients in the TEN group.There was no significant difference in Constant scores between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.

ABSTRACT

Background: With changing trends in treatment of displaced midshaft clavicle fractures (DMCF), plating remains the standard procedure for fixation. An attracting alternative method of fixation is the titanium elastic nailing (TEN). However, prospective randomized studies comparing the two methods of fixation are lacking. We assessed the effectiveness of minimally invasive antegrade TEN and plating technique for the treatment of DMCF.

Materials and methods: 80 unilateral displaced midclavicular fractures operated between October 2010 and May 2013 were included in study. This prospective comparative study was approved by the local ethical committee. Followups were at 2(nd) and 6(th) weeks and subsequently at 3, 6, 12, 18 and 24 months postoperatively. Primary outcome was measured by the Constant score, union rate and difference in clavicular length after fracture union. Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications.

Results: During analysis, we had 37 patients in the plate group and 34 patients in the TEN group. There was no significant difference in Constant scores between the two groups. However, faster fracture union, lesser operative time, lesser blood loss, easier implant removal and fewer complications were noted in the TEN group.

Conclusion: The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal and fewer complications; although for comminuted fractures plating remains the procedure of choice.

No MeSH data available.


Related in: MedlinePlus

A 21 year old male patient with left clavicle fracture treated by titanium elastic nailing. (a) Preoperative x-ray showing fracture clavicle (b) peroperative fluoroscopic image showing closed reduction with percutaneous reduction clamps, (c) postoperative skiagram showing intramedullary implant (d) union achieved at 3 months postoperatively
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4232828&req=5

Figure 3: A 21 year old male patient with left clavicle fracture treated by titanium elastic nailing. (a) Preoperative x-ray showing fracture clavicle (b) peroperative fluoroscopic image showing closed reduction with percutaneous reduction clamps, (c) postoperative skiagram showing intramedullary implant (d) union achieved at 3 months postoperatively

Mentions: After anesthesia, patients were placed in supine position. The sternoclavicular joint was palpated and marked on the affected side. We used image intensification in 45°-cephalad and 45°-caudal directions. This provided us with images in two-planes, 90° apart. A small incision was made approximately 1 cm lateral to the sternoclavicular joint. The anterior cortex was opened using a sharp, pointed awl. A TEN was inserted (the diameter varied from 2 to 3 mm depending on the width of the bone). Before introduction, the original curvature of the small and flattened nail tip was straightened slightly to allow better gliding in the small medullary canal [Figure 2]. Closed reduction was performed under fluoroscopic control using two percutaneously introduced pointed reduction clamps [Figure 3]. If closed reduction failed, an additional incision (miniopen) was made above the fracture site for direct manipulation of the main fragments. The nail was then advanced manually until it was just medial to the acromioclavicular joint. Accurate maneuvering of the nail tip was necessary under fluoroscopic control to avoid penetration of the thin dorsal cortex. After reaching the end point, the fracture was compressed and the nail was cut close to the entry point to minimize soft tissue irritation, at the same time leaving sufficient length behind for easy extraction later on. The fascia and skin were closed in layers.


Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures: A comparative study.

Saha P, Datta P, Ayan S, Garg AK, Bandyopadhyay U, Kundu S - Indian J Orthop (2014)

A 21 year old male patient with left clavicle fracture treated by titanium elastic nailing. (a) Preoperative x-ray showing fracture clavicle (b) peroperative fluoroscopic image showing closed reduction with percutaneous reduction clamps, (c) postoperative skiagram showing intramedullary implant (d) union achieved at 3 months postoperatively
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232828&req=5

Figure 3: A 21 year old male patient with left clavicle fracture treated by titanium elastic nailing. (a) Preoperative x-ray showing fracture clavicle (b) peroperative fluoroscopic image showing closed reduction with percutaneous reduction clamps, (c) postoperative skiagram showing intramedullary implant (d) union achieved at 3 months postoperatively
Mentions: After anesthesia, patients were placed in supine position. The sternoclavicular joint was palpated and marked on the affected side. We used image intensification in 45°-cephalad and 45°-caudal directions. This provided us with images in two-planes, 90° apart. A small incision was made approximately 1 cm lateral to the sternoclavicular joint. The anterior cortex was opened using a sharp, pointed awl. A TEN was inserted (the diameter varied from 2 to 3 mm depending on the width of the bone). Before introduction, the original curvature of the small and flattened nail tip was straightened slightly to allow better gliding in the small medullary canal [Figure 2]. Closed reduction was performed under fluoroscopic control using two percutaneously introduced pointed reduction clamps [Figure 3]. If closed reduction failed, an additional incision (miniopen) was made above the fracture site for direct manipulation of the main fragments. The nail was then advanced manually until it was just medial to the acromioclavicular joint. Accurate maneuvering of the nail tip was necessary under fluoroscopic control to avoid penetration of the thin dorsal cortex. After reaching the end point, the fracture was compressed and the nail was cut close to the entry point to minimize soft tissue irritation, at the same time leaving sufficient length behind for easy extraction later on. The fascia and skin were closed in layers.

Bottom Line: Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications.During analysis, we had 37 patients in the plate group and 34 patients in the TEN group.There was no significant difference in Constant scores between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.

ABSTRACT

Background: With changing trends in treatment of displaced midshaft clavicle fractures (DMCF), plating remains the standard procedure for fixation. An attracting alternative method of fixation is the titanium elastic nailing (TEN). However, prospective randomized studies comparing the two methods of fixation are lacking. We assessed the effectiveness of minimally invasive antegrade TEN and plating technique for the treatment of DMCF.

Materials and methods: 80 unilateral displaced midclavicular fractures operated between October 2010 and May 2013 were included in study. This prospective comparative study was approved by the local ethical committee. Followups were at 2(nd) and 6(th) weeks and subsequently at 3, 6, 12, 18 and 24 months postoperatively. Primary outcome was measured by the Constant score, union rate and difference in clavicular length after fracture union. Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications.

Results: During analysis, we had 37 patients in the plate group and 34 patients in the TEN group. There was no significant difference in Constant scores between the two groups. However, faster fracture union, lesser operative time, lesser blood loss, easier implant removal and fewer complications were noted in the TEN group.

Conclusion: The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal and fewer complications; although for comminuted fractures plating remains the procedure of choice.

No MeSH data available.


Related in: MedlinePlus