A study on displaced mid-clavicular fractures treated by titanium elastic nailing system (Tens)

Abstract

Introduction: The mid shaft clavicle fractures account for 70-80% of all clavicular fractures. Intramedullary devices behave as internal splints that maintain alignment without rigid fixation. TENS provide a three point fixation within S-shaped clavicle and effectively control rotation, angulation and shortening.Materials and Methods: study included 21 patients aged between 18 to 60 years who underwent CRIF/ORIF with TENS for mid clavicular fractures in Department of Orthopedics, SMCH. Percutaneous nails are placed from medial to lateral direction. Entry point is 1 cm lateral to sternoclavicular joint. 5 to 10 mm longitudinal skin incision made 2mm medial to entry point in clavicle. In open approach a small vertical incision made at level of fracture. Post operative follow up done at postoperative day 10, 3 weeks, 6 weeks, 4 months, 6 months.Results: Timing of operation was 2 to 15 days from date of injury. Close reduction was done in 6 cases and open reduction required in 15 cases. DASH score was 5 -10 at 24 weeks and constant shoulder score was 95-100 at 24 weeks. Time for clinical union was 6 to 12 weeks and for radiological union was 12 to 14 weeks.Discussion: TENS are only indicated for OTA type A and B mid clavicular fractures. Diameter of nail should not be less than half of that of medullary cavity.Conclusion: Fixation of displaced mid clavicular fracture with TENS is technically demanding and minimal invasive, early functional recovery and 100% rate of fracture union. Study gives sufficient evidence of excellence of this procedure in OTA type A midclavicular fractures, preferably transverse or short oblique fracture.