FUNCTIONAL AND RADIOLOGICAL ANALYSIS OF MIDSHAFT CLAVICLE FRACTURE TREATED WITH TENS NAILING
DOI:
https://doi.org/10.67772/pq931t30Keywords:
Midshaft Clavicle fracture, Titanium Elastic Nailing, Functional outcome, Radiological outcome, Prospective study, Fracture healing, Constant and Murley scoringAbstract
Introduction: Clavicle fracture is the most frequently and easily fractured bone due to fall on outstretched hand or direct impact. Mainly the midshaft clavicle fracture is 80% compare to medial and lateral end clavicle fracture. Amongest all fractures the incidence of clavicle fracture is 3-5%.Tretement consist of mainly two procedure open reduction with plate or minimally invasive close reduction with TENS nail.
Material & Methods: A prospective study was conducted from November 2022 to January 2025 with 30 patients whose plain radiograps shows midshaft clavicle fractures. This study was conducted at our orthopaedic institute which a tertiary care centre.Patients treated with TENS nailing and Functional outcomes were assessed using the Constant-Murley score, and radiological healing assessed with help of follow-up X-rays. Outcomes were analyzed at 4 weeks 8 weeks, 12 weeks, and 6 months post-operation.Implant removal done within 1 year and after 6 month of surgery
Results: Among 30 patients we achieved closed reduction of fracture in 25 patients with lesser blood loss while in remaining 5 patients required open reduction of fracture site using bone holding and artery forcep.In all patient clinical union occurs at 5 weeks on an average and radiologically union occurs on an average 10weeks.
Conclusion: TENS nailing may offer a promising option for the treatment of clavicle shaft fractures as it is minimally invasive require less time for surgery (approx 30min)and patient can mobilize eary with short span of hospital stay(1day postoperatively). providing functional recovery with minimal complications and having superior cosmetic results.
References
1.Duan X, Zhong G, Cen S, Huang F, Xiang Z. Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. Journal of Shoulder and Elbow Surgery. 2011 Sep 1;20(6):1008-15.
2.Frigg A, Rillmann P, Perren T, Gerber M, Ryf C. Intramedullary nailing of clavicular midshaft fractures with the titanium elastic nail: problems and complications. The American Journal of Sports Medicine. 2009 Feb;37(2):352-9.
3.Hill JM. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. The Journal of Bone & Joint Surgery British Volume. 1997 Jul 1;79(4):537-8.
4.Khalil A. Intramedullary screw fixation for midshaft fractures of the clavicle. International orthopaedics. 2009 Oct;33:1421-4.
5.McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. JBJS. 2006 Jan 1;88(1):35-40.
6.Mueller M, Rangger C, Striepens N, Burger C. Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails. Journal of Trauma and Acute Care Surgery. 2008 Jun 1;64(6):1528-34.
7.Schuind F, Pay-Pay E, Andrianne Y, Donkerwolcke M, Rasquin C, Burny F. External fixation of the clavicle for fracture or non-union in adults. JBJS. 1988 Jun 1;70(5):692-5.
8.Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. Journal of orthopaedic trauma. 2005 Aug 1;19(7):504-7.
9.Grassi FA, Tajana MS, D’Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. Journal of Trauma and Acute Care Surgery. 2001 Jun 1;50(6):1096-100.
10.Leppilahti J, Jalovaara P. Migration of Kirschner wires following fixation of the clavicle-a report of 2 cases. Acta Orthopaedica Scandinavica. 1999 Jan 1;70(5):517-9.
11.Lyons FA, Rockwood Jr CA. Migration of pins used in operations on the shoulder. JBJS. 1990 Sep 1;72(8):1262-7.
12.Naidoo P. Migration of a Kirschner Wire from the clavicle into the abdominal aorta. Archives of Emergency Medicine. 1991 Dec;8(4):292.
13.Neer CS. Nonunion of the clavicle. Journal of the American Medical Association. 1960 Mar 5;172(10):1006-11.
14.Neviaser JS. The treatment of fractures of the clavicle. Surgical Clinics of North America. 1963 Dec 1;43(6):1555-63.
15.ROWE CR. 4 An Atlas of Anatomy and Treatment of Midclavicular Fractures. Clinical Orthopaedics and Related Research (1976-2007). 1968 May 1;58:29-42.
16.Society CO. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial.
17.Hill JM. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. The Journal of Bone & Joint Surgery British Volume. 1997 Jul 1;79(4):537-8.
18.McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. JBJS. 2006 Jan 1;88(1):35-40.
19.Society CO. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial.
20.Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. Journal of Trauma and Acute Care Surgery. 1997 Nov 1;43(5):778-83.
21.Poigenfürst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury. 1992 Jan 1;23(4):237-41.
22.Kuner EH, Schlickewei W, Mydla F. Surgical therapy of clavicular fractures, indications, technic, results. Hefte zur Unfallheilkunde. 1982 Jan 1;160:76-83.
23.Bronz G, Heim D, Pusterla C, Heim U. Osteosynthesis of the clavicle (author's transl). Unfallheilkunde. 1981 Aug 1;84(8):319-25.
24.Freeland A. Unstable adult midclavicular fracture. Orthopedics. 1990 Nov 1;13(11):1279-81.
25.Bostman O, Manninen M, Pihlajamaki H. Complications of Wilk KE. The shoulder. Chapter-15, In Malone TR, McPoil TG, Nitz AJ, editors, Orthopaedics and sports physical therapy, 3rd edition, St.Louis : Mosby 1997; 401-409 plate fixation in fresh displaced midclavicular fractures. J Trauma 1997; 43: 778-83
26.Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clinical Orthopaedics and Related Research®. 2003 Mar 1;408:279-85.
27.Chu CM, Wang SJ, Lin LC. Fixation of mid-third clavicular fractures with knowles pins: 78 patients followed for 2-7 years. Acta Orthopaedica Scandinavica. 2002 Apr 1;73(2).
28.Jubel A, Andermahr J, Faymonville C, Binnebösel M, Prokop A, Rehm KE. Reconstruction of shoulder-girdle symmetry after midclavicular fractures. Stable, elastic intramedullary pinning versus rucksack bandage: Elastisch stabile intramedulläre Osteosynthese vs. Rucksackverband. Der Chirurg. 2002 Oct;73:978-81.
29.Hartmann F, Hessmann MH, Gercek E, Rommens PM. Elastic intramedullary nailing of midclavicular fractures. Acta chirurgica Belgica. 2008 Jan 1;108(4):428-32.
30.Wang YC, Fu YC, Chou SH, Liu PC, Tien YC, Lu CC. Titanium Elastic Nail versus plate fixation of displaced midshaft clavicle fractures: a retrospective comparison study. The Kaohsiung Journal of Medical Sciences. 2015 Sep 1;31(9):473-9.
31.Masatwar PV, Chishti SN, Singh SN, Maske RG, Soring D, Parija D. A prospective study of operative management of simple midshaft clavicular fracture with titanium elastic nail (TEN). International Journal of Orthopaedics. 2016;2(4):210-3.
32.Itagi PB, Pattanshetty AS. A comparative study of plate fixation versus titanium elastic nail in treatment of displaced midshaft clavicle fractures. International Journal of Orthopaedics. 2021;7(4):672-6.
33.Jones LD, Grammatopoulos G, Kambouroglou G. Titaniun elastic nails, open reduction internal fixation and non-operative management for middle third clavicle fractures: a comparative study. Eur J Orthop Traumatol. 2014; 24(3):323-9.
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