Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 22-27 | Sreejith Thampy J, Arun H S, Prabhu E, Hariprasad S
Authors: Sreejith Thampy J , Arun H S , Prabhu E , Hariprasad S 
 Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka.
Address of Correspondence
Dr. Arun H S,
Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka.
Purpose: Conservative methods were commonly used for midshaft clavicle fracture treatment, but with complications such as non-union, malunion, and shoulder asymmetry. Early surgical treatment for midshaft clavicular fractures could greatly reduce the same. Open reduction and internal fixation with plate and intramedullary fixation are the commonly used surgical techniques. Plating was considered as the gold standard in view of firm fixation and early rehabilitation, but with larger incision and soft-tissue exposure. Intramedullary fixation has been favored for its small incision, less periosteal striping, faster union, and less operating time. Here, we assess the functional outcome following titanium elastic nailing system (TENS) application.
Methodology: It is a prospective cohort study (evidence level II), 60 patients fitting as per inclusion and exclusion criteria presenting to our orthopedic department from July 2017 to May 2019 are included in the study after obtaining informed consent.
Results: Among 60 patients treated with TENS, excellent functional outcome was seen in 50 patients (83.3%) by the 3rd month and 54 (90%) by the 6th month using Constant and Murley scoring system. In our study, 66.6% of cases had union by the 3rd month and rest all by 6 months.
Conclusion: TENS should be considered as primary option for midshaft clavicle fracture with mild-to-moderate comminution.
Keywords: Midshaft clavicle fracture, Locking compression plate, Titanium elastic nailing system, Intramedullary nailing, Closed reduction and nailing, Mini-open incision.
1. Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Green’s Fractures in Adults. 8th ed. Philadelphia, PA: Wolters Kluwer; 2015. p. 1427-70.
2. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 1988;70:461-4.
3. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a 2-year period in Uppsala, Sweden. Injury 2000;31:353-8.
4. Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular fracture: Not just a trivial injury-current treatment options. Dtsch Arztebl Int 2010;107;711-7.
5. Neer CS. Nonunion of the clavicle. J Am Med Assoc 1960;172:1006-11.
6. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
7. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier; 2008. p. 3371-6.
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. J Orthop Trauma 2005;19:504-7.
9. University of Utrecht. (2017). Operative treatment of displaced clavicle fractures: optimising implant choice.
10. McKee MD, Wild LM, Schemitsch EH. Midshaft malunion of the clavicle. J Bone Joint Surg Am 2003;85:790-7.
11. Suhail AB, Khursheed AB, Sanjeev G, Lone MS, Bhat A, Ali N. Changing trends in management of adult clavicular fractures. IJAR 2014;6:843-9.
12. Kettler M, Schieker M, Braunstein V, König M, Mutschler W. Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: Technique and results in 87 patients. Acta Orthop 2007;78:424-9.
13. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987;214:160-4.
14. Robinson CM, Brown CM, McQueen MM, Walkefield AE. Estimating the risk of non-union following non operative treatment of a clavicular fracture. J Bone Joint Surg Am 2004;86:1359-65.
15. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997;79:537-40.
16. Nordgvist A, Petersson CJ, Redlund-Johnell I. Mid clavicular fractures in adults: End result study after conservative treatment. J Orthop Trauma 1998;12:572-6.
17. Guerra TE, Pozzi IM, Busin G, Zanetti LC, Lopes JA, Orso V. Densitometric study of the clavicle: Bone mineral density explains the laterality of the fractures. Rev Bras Ortop 2014;49:468-72.
18. Mueller M, Rangger C, Striepens N, Burger C. Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails. J Trauma 2008;64:1528-34.
19. Slongo TF. Complications and failures of the ESIN technique. Injury 2005;36:78-85.
20. Zhang B, Zhu Y, Zhang F, Chen W, Tian Y, Zhang Y. Meta-analysis of plate fixation versus intramedullary fixation for the treatment of mid-shaft clavicle fractures. Scand J Trauma Resusc Emerg Med 2015;23:27.
21. Meier C, Grueninger P, Platz A. Elastic stable intramedullary nailing for midclavicular fractures in athletes: Indications, technical pitfalls and early results. Acta Orthop Belg 2006;72:269-75.
|How to Cite this article: Thampy JS, Arun H S, Prabhu E, Hariprasad S | Study of Functional Outcome in Midshaft Clavicle Fracture Treated With Titanium Elastic Nailing System | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 22-27.|