Nina Kabelitz1, Method Kabelitz2, Herman Frima3, Alexandra Rehm4, Christoph Sommer5, Christian Michelitsch5. 1. Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland. kabelitznina@gmail.com. 2. Department of Orthopaedic Surgery, Spitalregion Rheintal Werdenberg Sarganserland, Spitalstrasse 44, 9472, Grabs, Switzerland. 3. Department of Trauma Surgery, Noordwest Hospital Group, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands. 4. Department of Endocrinology and Diabetes, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany. 5. Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Abstract
PURPOSE: Midshaft clavicle fractures represent about 4% of all fractures in the emergency department. Non-operative treatment of displaced midshaft clavicle fractures (DMCF) can result in a relatively high non-union rate. Several operative techniques, including intramedullary fixation (IMF) using elastic stable intramedullary nailing (ESIN), have therefore been established. IMF through the medial approach is less suitable for fractures of the lateral diaphysis. IMF of DMCF of the lateral diaphysis through a lateral approach can be an alternative approach for these fractures. The aim of this study is to describe the technique of IMF from the lateral side and to present the functional outcome and complications. METHODS: A retrospective cohort study was performed. All patients with a traumatic DMCF treated with IMF using ESIN through a lateral approach between 2014 and 2019 were included. Endpoints were the functional outcome (QuickDASH, Subjective Shoulder Value (SSV)), pain (numeric rating scale (NRS)), daily impairment (activities of daily living (ADL)), complications and implant removal. RESULTS: Forty out of 43 patients were available for follow-up. Mean follow-up was 37 months. Mean age was 24 years (range 13-70). The median QuickDASH score was 0 (IQR 0.0-0.0) and the median SSV was 100 (95-100). The median ADL score was 1 (1-4) and the median NRS was 0 (0-0). No non-union occurred. Implant related irritation occurred in 11 patients (27.5%). Implants were removed in a total of 38 (95%) patients; in 10 cases due to irritation, in 28 cases routinely or on patient's request. CONCLUSION: IMF of DMCF of the lateral diaphysis through a lateral approach leads to excellent functional results and seems to be a suitable option for internal fixation. However, as with IMF from the medial side, it is not without complications and implant-related irritation.
PURPOSE: Midshaft clavicle fractures represent about 4% of all fractures in the emergency department. Non-operative treatment of displaced midshaft clavicle fractures (DMCF) can result in a relatively high non-union rate. Several operative techniques, including intramedullary fixation (IMF) using elastic stable intramedullary nailing (ESIN), have therefore been established. IMF through the medial approach is less suitable for fractures of the lateral diaphysis. IMF of DMCF of the lateral diaphysis through a lateral approach can be an alternative approach for these fractures. The aim of this study is to describe the technique of IMF from the lateral side and to present the functional outcome and complications. METHODS: A retrospective cohort study was performed. All patients with a traumatic DMCF treated with IMF using ESIN through a lateral approach between 2014 and 2019 were included. Endpoints were the functional outcome (QuickDASH, Subjective Shoulder Value (SSV)), pain (numeric rating scale (NRS)), daily impairment (activities of daily living (ADL)), complications and implant removal. RESULTS: Forty out of 43 patients were available for follow-up. Mean follow-up was 37 months. Mean age was 24 years (range 13-70). The median QuickDASH score was 0 (IQR 0.0-0.0) and the median SSV was 100 (95-100). The median ADL score was 1 (1-4) and the median NRS was 0 (0-0). No non-union occurred. Implant related irritation occurred in 11 patients (27.5%). Implants were removed in a total of 38 (95%) patients; in 10 cases due to irritation, in 28 cases routinely or on patient's request. CONCLUSION: IMF of DMCF of the lateral diaphysis through a lateral approach leads to excellent functional results and seems to be a suitable option for internal fixation. However, as with IMF from the medial side, it is not without complications and implant-related irritation.
Authors: Herman Frima; Mark van Heijl; Christian Michelitsch; Olivier van der Meijden; Frank J P Beeres; Roderick M Houwert; Christoph Sommer Journal: Eur J Trauma Emerg Surg Date: 2019-04-03 Impact factor: 3.693
Authors: Martijn H J Hulsmans; Mark van Heijl; R Marijn Houwert; Eric R Hammacher; Sven A G Meylaerts; Michiel H J Verhofstad; Marcel G W Dijkgraaf; Egbert J M M Verleisdonk Journal: Clin Orthop Relat Res Date: 2016-11-09 Impact factor: 4.176
Authors: M H J Hulsmans; M van Heijl; H Frima; O A J van der Meijden; H R van den Berg; A H van der Veen; A C Gunning; R M Houwert; E J M M Verleisdonk Journal: Eur J Trauma Emerg Surg Date: 2017-10-09 Impact factor: 3.693