Outcome of elastic stable intramedullary nailing of displaced midshaft clavicular fracture: does the presence of fracture comminution differ?

Abstract

Background The mainstay of the treatment of the fractures of the clavicle has been nonoperative, even with substantial displacement. Elastic stable intramedullary nailing of displaced midshaft clavicular fracture is a relatively new method for stabilization of these fractures, having a significantly lower rate of complications and earlier return of function. However, there is no general consensus about its indications, especially in comminuted fractures. Materials and methods A prospective study of 46 patients with displaced midshaft clavicular fractures was conducted to evaluate the efficacy and safety of fixation of such fractures using titanium elastic intramedullary nail and to assess the effect of the presence of fracture comminution on the final outcome. Patients were divided into two groups. Group I comprised 21 patients with noncomminuted fractures, whereas group II comprised 25 patients with comminuted fractures. The primary outcome measure was the Constant shoulder score, and the secondary outcome measures included the following: the disability of the arm, shoulder and hand (DASH) score, the union rate, the duration of union, the patients’ satisfaction as regards the cosmetic results, and the prevalence of complications related to surgery. Results All patients were available for follow-up after a minimum of 1 year postoperatively. Osseous union was achieved in all patients in both groups, except in one patient in group II. The median Constant and DASH scores showed progressive postoperative improvement in both groups throughout the follow-up period. At 6 weeks postoperatively, the median Constant and the DASH scores in the noncomminuted group (group I) were significantly better than that in group II (P Conclusion This study has shown that elastic stable intramedullary nailing of displaced midshaft clavicular fractures gives good cosmetic and functional results with minimal morbidity and complications. Medial prominence of the elastic nail was the most common complication. The presence of fracture comminution was associated with a delayed functional recovery; however, it did not affect the final functional outcome or the cosmetic result.