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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

Clinical photograph showing complications of titanium elastic nailing in displaced midshaft clavicle fractures. (a) Medial hardware prominence, (b) lateral hardware prominence (black arrow)
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Figure 5: Clinical photograph showing complications of titanium elastic nailing in displaced midshaft clavicle fractures. (a) Medial hardware prominence, (b) lateral hardware prominence (black arrow)

Mentions: Major complications were noted in 5 patients [infection (n= 4) and nonunion (n = 1)] in the plate group, while none in the TEN group [Table 4]. Infections were controlled by debridement followed by intravenous antibiotics without removing the implants (as fixation was stable). The nonunion case in our series required revision surgery with bone grafting and healed thereafter uneventfully. In the plate group, subjective evaluation of cosmetic results was poor in 13 patients [ugly scar (n = 6), hardware prominence (n = 9)] [Figure 4] when compared to 12 patients in the TEN group [hypertrophic callus (n = 1) medial hardware prominence (n = 11) and lateral hardware prominence (n = 1)] [Figure 5].


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)

Clinical photograph showing complications of titanium elastic nailing in displaced midshaft clavicle fractures. (a) Medial hardware prominence, (b) lateral hardware prominence (black arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Clinical photograph showing complications of titanium elastic nailing in displaced midshaft clavicle fractures. (a) Medial hardware prominence, (b) lateral hardware prominence (black arrow)
Mentions: Major complications were noted in 5 patients [infection (n= 4) and nonunion (n = 1)] in the plate group, while none in the TEN group [Table 4]. Infections were controlled by debridement followed by intravenous antibiotics without removing the implants (as fixation was stable). The nonunion case in our series required revision surgery with bone grafting and healed thereafter uneventfully. In the plate group, subjective evaluation of cosmetic results was poor in 13 patients [ugly scar (n = 6), hardware prominence (n = 9)] [Figure 4] when compared to 12 patients in the TEN group [hypertrophic callus (n = 1) medial hardware prominence (n = 11) and lateral hardware prominence (n = 1)] [Figure 5].

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