Shoulder
Surgical management of uncomplicated midshaft clavicle fractures: a comparison between titanium elastic nails and small reconstruction plates

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Background

This study compared titanium elastic nail (TEN) fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures.

Methods

The records of 57 patients with midshaft clavicular fractures that were operated on within 2 weeks after injury at Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, were retrospectively analyzed. Each patient received either TENs (n = 25) or fixation with a 3.5-mm reconstruction plate (n = 32) depending on the preference of the operating surgeon. Operative parameters, postoperative pain and function scores, complications, and fracture union time were determined.

Results

There was no difference in the fracture pattern distribution between the 2 groups, and all operations were performed without complications. Operation time, wound size, blood loss, length of hospitalization, and subjective time to pain relief were less for the TEN group than for the 3.5-mm reconstruction plate fixation group (P < .001 for all). Patients in the TEN group showed a greater range of shoulder motion and higher Constant scores than those in the plate fixation group up to 18 weeks after surgery (P < .001 for all). Fewer patients in the TEN group, 4 (16%), requested removal of the implant, as compared with 12 (37.5%) in the plate group.

Conclusion

Fixation of uncomplicated midshaft clavicle fractures with TENs provides adequate fixation and faster relief of pain and return to normal function of the affected shoulder than fixation with 3.5-mm reconstruction plates.

Section snippets

Methods

We conducted a retrospective, case-controlled study on patients with clavicular fractures that were surgically treated at our hospital from January to December 2007. Open fractures, complex comminuted fractures (type 2B2), nonunion after 6 months of conservative therapy, and cases in which treatment was delayed for more than 3 weeks after injury were excluded because such cases are considered a strong indication for plate fixation. In addition, cases with neurovascular injury or multiple

Results

On the basis of the previously described criteria, the records of 57 patients with acute, displaced (>1 cm), closed midshaft clavicular fractures that were operated on within 2 weeks after injury were included in this analysis. There were 28 male and 29 female patients ranging in age from 14 to 66 years, and there were 25 patients in the TEN group and 32 in the SRP fixation group. Table I presents a summary of the demographic characteristics of the patients in each group. There were no

Discussion

We designed this retrospective study to compare the outcomes of patients with uncomplicated midshaft clavicle fractures treated with TEN fixation or 3.5-mm reconstruction plate fixation and found that operation time, wound size, blood loss, length of hospitalization, and subjective time to pain relief were less for the TEN group than for the SRP fixation group (P < .001 for all). Patients in the TEN group showed greater shoulder ROM and higher Constant scores than those in the SRP group up to

Conclusions

The results of this study comparing outcomes of TEN and plate fixation for uncomplicated midshaft clavicular fractures indicate that TENs provide adequate fixation and faster relief of pain and return to normal function of the affected shoulder.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    Review board approval for this study was attained from the Institutional Review Board of Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

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