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Kang Y, Zhang Q, Ma Y, Zhou M, Jia X, Lin F, Wu Y, Rui Y. Clinical effect of nice knot-assisted minimally invasive titanium elastic nail fixation to treat Robinson 2B midshaft clavicular fracture. BMC Musculoskelet Disord 2024; 25:59. [PMID: 38216916 PMCID: PMC10787378 DOI: 10.1186/s12891-024-07197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/11/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures. METHODS A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded. RESULTS The length of the incision was 2-6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92-100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12-26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm). CONCLUSIONS Intramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures. TRIAL REGISTRATION Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People's Hospital (LW20220021).
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Affiliation(s)
- Yongqiang Kang
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Qingqing Zhang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Yunhong Ma
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Ming Zhou
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Xueyuan Jia
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Fang Lin
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Yongwei Wu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
| | - Yongjun Rui
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
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Haouzi M, Amraoui B, Akkoumi A, Dinia M, Bassir R, Boufettal M, Mekkaoui J, Lamrani M, Kharmaz M, Berrada M. Bilateral clavicle fracture: A case report. Trauma Case Rep 2023; 46:100861. [PMID: 37347004 PMCID: PMC10279895 DOI: 10.1016/j.tcr.2023.100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
Clavicle fractures are among the most common fractures in adults. Nevertheless, bilateral fractures are rarely reported in the literature. We present the case of a 35-year-old male patient who was admitted with a bilateral clavicle fracture following a motorcycle accident. The patient underwent open reduction and bilateral intramedullary fixation with Kirschner wires. After six months of follow-up, the functional result was satisfactory; the patient achieved full range of motion in both shoulders and was free from pain. X-rays showed a complete fusion of the fracture on both sides.
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Sun DD, Lv D, Zhou K, Chen J, Gao LL, Sun ML. External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study. BMC Musculoskelet Disord 2021; 22:1. [PMID: 33397351 PMCID: PMC7780413 DOI: 10.1186/s12891-020-03840-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.
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Affiliation(s)
- Dong-Dong Sun
- Department of Orthopedic, Characteristic Medical center of Chinese People's Armed Police Force, No. 220 Cheng Lin Road, Tianjin, 300171, China.,Logistics University of People's Armed Police, Tianjin, 300300, China
| | - Dan Lv
- Department of Orthopedic, Characteristic Medical center of Chinese People's Armed Police Force, No. 220 Cheng Lin Road, Tianjin, 300171, China
| | - Kun Zhou
- Logistics University of People's Armed Police, Tianjin, 300300, China
| | - Jian Chen
- Logistics University of People's Armed Police, Tianjin, 300300, China
| | - Li-Lan Gao
- School of Mechanical Engineering, Tianjin University of Technology, No. 391 Bin Shui West Road, Tianjin, 300384, China.
| | - Ming-Lin Sun
- Department of Orthopedic, Characteristic Medical center of Chinese People's Armed Police Force, No. 220 Cheng Lin Road, Tianjin, 300171, China.
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Langenhan R, Bushuven S, Reimers N, Probst A. S-shaped titanium endomedullary nail reduces telescoping of comminuted midshaft clavicular fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:391-398. [PMID: 32902717 DOI: 10.1007/s00590-020-02783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The surgical treatment of displaced midshaft clavicular fractures (DMCF) is clinically relevant and a much discussed topic. The axial stability of DMCF after intramedullary nailing (IMN) is still a matter of debate. OBJECTIVE Our objective was to present a modification of IMN of DMCF with S-shaped titanium endomedullary nail (TEN) and determine fracture telescoping from day one after surgery to the time of fracture healing. METHOD In a prospective analytic cohort study over a 6-year period (2012-2017) at a Level II trauma care centre, a total of 128 patients with DMCF were included and classified according to the AO/OTA classification system. Group I was AO/OTA type 15.2A/15.2B (N = 68) and group II was AO/OTA type 15.2C (N = 60). After a modified open stabilization technique of each DMCF with IMN (S-shaped TEN), the dynamics of radiological assessed telescoping until union and rate of surgical adverse events were measured. Significance was assumed for p < 0.05. RESULTS One day after surgery, fractured clavicles were lengthened slightly in both groups compared to the unfractured clavicules (group I: 1.2%; group II: 0.9%). After osseus consolidation, the fractured clavicules were significantly shortened in both groups (group I: - 2.9%; group II: - 3.6%). Measurement of the clavicular shortening at one day postsurgically and at consolidation revealed a mean telescoping of - 3.99% in group I and of - 4.6% in group II. The difference between the two groups was not significant (P = 0.522). The overall rate of major surgical adverse events was 2.3%. CONCLUSION The proposed operative technique of IMN (stabilization of the DMCF with a long, S-shaped, tight-fitting TEN) provides enough axial stability to prevent significant telescoping of the comminuted fractures. The rate of nonunion is low and the overall rate of major adverse events is similar to the reported events after plate fixation in the literature.
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Affiliation(s)
- Ronny Langenhan
- Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224, Singen, Germany.
| | - Stefanie Bushuven
- Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224, Singen, Germany
| | - Niklas Reimers
- Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224, Singen, Germany.,Department of Orthopaedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116, Chemnitz, Germany
| | - Axel Probst
- Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224, Singen, Germany
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King PR, Lamberts RP. Management of clavicle shaft fractures with intramedullary devices: a narrative review. Expert Rev Med Devices 2020; 17:807-815. [PMID: 32635794 DOI: 10.1080/17434440.2020.1793668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Displaced and shortened clavicle fractures are frequently treated surgically. Although extramedullary fixation using a plate and screws is most commonly used, intramedullary nailing has become increasingly popular over the last decade. Traditional intramedullary nailing is usually associated with a high risk of hardware migration as well as hardware irritation at its entry point. Newer devices, however, seem to mitigate these problems. The aim of this narrative review is to provide an overview of clavicle shaft fractures and treatment with intramedullary nails, in particular the newer, locked devices. AREAS COVERED In general, this review covers current literature related to clavicle shaft fractures with a specific focus on the treatment of displaced and shortened fractures with intramedullary nails. EXPERT OPINION Clavicle shaft fractures can be effectively treated with an intramedullary nail. The risk of hardware migration when employing the newer, improved designs appears to be minimal. The advantages of using intramedullary fixation include smaller incision sizes as well as the avoidance of routine procedures generally associated with the removal of prominent subcutaneous hardware as per extramedullary fixation.
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Affiliation(s)
- Paul Reginald King
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa
| | - Robert Patrick Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa
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Li L, Li TY, Jiang P, Lin G, Wu H, Han X, Yu X. Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures. J Orthop Surg Res 2019; 14:472. [PMID: 31888668 PMCID: PMC6936130 DOI: 10.1186/s13018-019-1518-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this meta-analysis was to compare clavicle hook plates versus distal clavicle locking plates for the treatment of Neer type II distal clavicle fractures. Methods PubMed (1996 to January 2019), Embase (1980 to January 2019), Web of Science (1990 to January 2019), the Cochrane Library (January 2019), and the China National Knowledge Infrastructure (January 2019) were systematically searched without language restrictions for literature retrieval. The Constant-Murley shoulder joint function score at 3 and 6 months after the operation and the postoperative complications after the operation (shoulder joint pain, abduction restriction, fracture delay healing, subacromial impingement) were the outcomes. Stata 12.0 was used for the meta-analysis. Results A total of 9 clinical trials involving 446 patients were finally included in this meta-analysis. The results showed that the improvement in the Constant-Murley shoulder joint function score in the distal locking plate group was better than that in the clavicle hook plate group at 3 and 6 months after the operation (P < 0.05). There were fewer cases of shoulder joint pain and restricted shoulder abduction range of motion in the distal locking plate group, and the difference was statistically significant (P < 0.05). There were no statistically significant differences in fracture delay healing and subacromial impingement between the two groups (P > 0.05). Conclusion Compared with the clavicular hook plate, the distal clavicle locking plate for the treatment of Neer type II distal clavicle fractures is associated with better shoulder function recovery and fewer complications related to pain and abduction restriction.
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Affiliation(s)
- Liang Li
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China
| | - Tian-Yan Li
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China
| | - Peichao Jiang
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China
| | - Guizhen Lin
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China.
| | - Hongxiao Wu
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China
| | - Xiaochuan Han
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China
| | - Xuezhong Yu
- Department of Orthopaedics, Dongying People's Hospital, No. 317 Dongcheng South First Road, Dongying, 257091, Shandong, China
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