Abstract
Summary Treatment of clavicular midshaft fractures with the Titanium Elastic Nail (TEN) combined with free range of motion (ROM) postoperatively revealed a high complication rate of 78% without endcap and 60% with endcap in our experience. This study examined how to reduce this high complication rate. From 4/04 to 12/09 63 patients were treated percutaneously using TEN without endcap (n=19, group A) and with endcap (n=44, group B+C). In group B (n=15) the TEN was advanced with the oscillating drill and free ROM was allowed postoperatively. In group C (n=29) the TEN was inserted carefully with a T-handle and ROM was limited to 90°. Mean follow-up was 23 months (12-52). The complication rate decreased from 78% to 60% from group A to group B. The complications were then significantly reduced to 10% in group C. There were no more medial perforations with the Endcap. Limitation of ROM during 6 weeks postoperatively as well as careful advancement of the TEN reduced the complication rate significantly to an acceptable level. Intramedullary stabilisation of claviclular midshaft fractures with TEN is a minimally invasive technique with results comparable to the current gold standard of plate osteosynthesis.
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