Titanium Elastic Nail Fixation Research Articles

Comparative study of stabilization of a displaced midshaft clavicle fracture with either an intramedullary nail fixation or a superiorly placed plate.

This retrospective study compares two techniques of fixation of midshaft clavicle fractures: nail fixation versus plate fixation. We compared titanium elastic nail fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures. In total, 84 patients were included in our study: 35 in the nail fixation group and 49 in the plate fixation group. We compared the 12-month postoperative shoulder function and scar assessment. Primary outcome was measured by the DASH score and POSAS score. Secondary outcome was measured by Constant score, surgery complications, implant removal, hospitalization days, and size and quality of the scar. Here was no significant difference in DASH and Constant scores between the two groups. However, the nail group leads in the POSAS (12 (12 - 12) 25 (17 - 30) p < 0.001) and in all scar parameters (size, scar influence). There were no significant differences in the complications despite implant removal where more removals were noted in the nail group (16 (44.4%) 4 (8.3%) p < 0.001). Fixation of uncomplicated midshaft clavicle fractures with nail provides better cosmetic results and scar quality than fixation with plate, and presents no significant differences in functional ability or complications.

Challenges in the Surgical Orthopedic Treatment of Long Bone Fracture in a Rare Case of Pycnodysostosis

Pycnodysostosis is a rare autosomal recessive disorder caused by an inactivating mutation in cathepsin K (CTSK) and characterized by dysmorphic facial features, a short stature, acro-osteolysis, osteosclerosis with increased bone fragility, and delayed closure of cranial sutures. Although the satisfying healing potential, many issues exist in managing fractures in pycnodysostosis patients. In this paper, we report the challenges faced in managing a fracture of the femoral shaft in a 14-year-old boy coming from a low-income family. The patient was administered to the Paediatric Surgical Emergency Department of the Children's Hospital in Rabat for the management of a closed fracture of the left femur. Despite being of small stature with dysmorphic facial features, a prominent forehead, and brachydactyly, he never had a medical consultation before. The patient then underwent a surgical reduction. We attempted titanium elastic nail fixation, but metaphyseal drilling was not feasible due to the high bone density, and the narrow medullary canal eliminated this option. Therefore we opted for the palate fixation. Sclerotic bone made drilling extremely difficult. The postoperative fracture was successfully healed.

Outcomes of Titanium Elastic Nails (TENS) for Unstable Femoral Shaft Fracture Among children aged 6-13 years in Nepal: A Prospective Study

Introduction: Because of the innate fracture healing capacity in pediatric age group Titanium Elastic Nailing System (TENS) is an ideal stabilization method for diaphyseal femur fractures, especially in length stable fractures (transverse and short oblique) owing to its load sharing properties and minimum complications. However, the outcome of TENS in axially unstable pediatric femoral diaphyseal fractures (long oblique, spiral and comminuted) is not uniform and is still debated. Objectives: Analysis of radiological and functional outcomes of length unstable pediatric femoral fractures treated with titanium elastic nails (TENS) in the age group of 6–13 years. Methodology: A prospective study of 42 unstable pediatric femoral fractures treated with TENS from November 2022 to October 2023 at Birat Medical College Teaching Hospital, Biratnagar, Nepal was conducted and analyzed with functional and radiological outcomes. Results: As per Flynn's criteria 37 patients (88.1%) had excellent results, 4 patients (9.5%) had successful results, and 1patient (2.3%) had poor result. The mean time to full weight bearing after radiological fracture union was 8.1 weeks. Conclusion: Closed reduction and TENS fixation is an effective surgical procedure even for length unstable femoral diaphyseal fractures in children if appropriate surgical techniques and post-surgical care are followed.

Clinical effect of nice knot-assisted minimally invasive titanium elastic nail fixation to treat Robinson 2B midshaft clavicular fracture

BackgroundThe treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures.MethodsA retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded.ResultsThe length of the incision was 2–6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92–100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12–26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm).ConclusionsIntramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures.Trial registrationRetrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People’s Hospital (LW20220021).

Functional Outcome of Titanium Elastic Nail Fixation in Diaphyseal Fractures of Forearm in Adolescents

Introduction: This study aims to assess the functional outcomes of Titanium Elastic Nailing System (TENS) fixation for managing diaphyseal forearm fractures in adolescents. Method: The study was a prospective clinical study conducted at B.P. Koirala Institute of Health Sciences Between December 1, 2020, and November 30, 2021. Ethical clearance was obtained from the Institutional Review Committee (Registration Number 305/077/078-IRC). A total of 27 patients who underwent TENS fixation for forearm diaphyseal fractures were included. Patients were followed at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Radiological and functional outcome evaluations were assessed, including the range of motion, deformity, and time taken for union and active recovery. Collected data were entered in Microsoft Excel and converted to SPSS (Statistical Package for Social Sciences) version 28 for statistical analysis. Results: Among 27 included patients, 66.7% were males, 81.5% were within the age group of 10-13 years, 70.4% fell on outstretched hands, and 66.7% had fractures at the middle third of the forearm. Union was seen in 6 weeks among 29.6%, 12 weeks among 66.6%, and 24 weeks among 3.8%—7.4% developed complications. Conclusion: TENS is an effective fixation method for diaphyseal forearm fractures in adolescents and provides satisfactory functional outcomes. Keywords: Adolescents; Forearm bone fractures; Functional outcome; TENS

Outcomes of Treating Mid - Clavicular Fractures with Titanium Elastic Nail Fixation

Outcomes of Treating Mid - Clavicular Fractures with Titanium Elastic Nail Fixation

Mid-Term results in adult humeral fractures with titanium elastic nail fixation versus plate and screw fixation and locking intramedullary nailing

Aims: To compare plate-screw fixation, intramedullary nailing (IMN), and titanium elastic nailing (TEN) as a new fixation method with respect to nonunion, complication rates, and functional outcomes in the repair of adult humeral shaft fractures. Methods: A total of 38 adult patients who were treated due to humeral shaft fracture at our clinic and were followed for minimum six months between January 2012 and January 2015 were retrospectively analyzed. Age, sex, fracture etiology an length of hospitalization were recorded. Fractures were classified according to the Association for Osteosynthesis(AO) classification. Nonunion rates as assessed by X-ray during visits, angulation, shoulder, elbow and hand disability scores were evaluated using the DASH, Mayo Elbow and UCLA Shoulder scoring, and Stewart Hundley criteria. Results: There was no significant epidemiological difference between the groups. The length of hospitalization was lower in the TEN group. There was no significant difference in nonunion rates and functional scores according to the type of treatment. Angulation rate was slightly higher in the TEN group. The effect of angulation on functional score showed no influence on the functional status. The three treatment types mostly achieved excellent and good outcomes. Conclusion: Our study results suggest that TEN seems to be a good alternative treatment in eligible patients with humeral shaft fractures considering complications of other treatments. However, we believe that further, large-scale, randomized-controlled, prospective studies with longer follow-up duration are required to confirm these findings and to establish a definite conclusion. Level of Evidence: Therapeutic Level III.

Femur shaft fracture treatment in school-aged children using titanium elastic nails

Abstract INTRODUCTION: Titanium elastic nails are used to treat femur shaft fractures in paediatric patients. This method is minimally invasive and does not cause epiphyseal injury or impairment of femoral head blood supply. OBJECTIVES: The objective is to evaluate the results of operative treatment of femur shaft fractures in the age group between 6 and 16 years with titanium elastic nailing system (TENS), using Flynn’s criteria. METHODS: This prospective clinical study was conducted during the period from November 2018 to November 2020. Thirty cases were treated with mean follow up of 12 months. RESULTS: The final outcome was excellent in 21 cases, satisfactory in 6 cases and there were 3 poor outcome cases. Eight patients had limb length discrepancy varying from 0.5-2cm. Five patients had skin irritation, 3 patients had angular mal-union and 1 patient had persistent pain with skin breakdown. None of the patient had infection, rotational mal-union, delayed or non union. CONCLUSION: Titanium elastic nail fixation is a simple, easy and effective method for management of paediatric femur fracture between 6 and 16 years age. With this method of treatment, careful consideration to patient’s age and body weight should be given to prevent the poor result.

Outcomes of Treatment of Monteggia Fractures with Reduction and Internal Titanium Elastic Nail Fixation of the Ulna.

The purpose of this paper is to evaluate the usefulness of radiographic indices of humero-radial joint instability in order to predict treatment outcomes in Monteggia fractures. A retrospective analysis was conducted in a group of patients who underwent closed reduction and internal titanium elastic nail (TEN) fixation of the ulna and closed reduction of a dislocation of the radial head between 2016 and 2018. The indications for intrame-dullary fixation comprised transverse or short oblique fractures. The direction of the dislocation was classified according to Bado. The following radiographic indies were assessed: Radiocapitellar Line, Lateral Humeral Line, Proximity Index, and Radial Head Displacement Index. Treatment outcomes were assessed with the Oxford Elbow Score and Mayo Elbow Performance Score, and com-plications were assessed with a modified Clavien-Dindo-Sink scale. No coincidence between poor functional and radio-graphic outcomes was demonstrated. 1. Regardless of the severity of the injury, eligibility for surgery and correctly performed surgical treatment guarantee a good final outcome. 2. Patients treated with TEN regain their preoperative mobility. 3. There was no coincidence between poor functional and radiographic outcomes, except for one patient in whom subluxation of the radial head persisted despite surgery and was confirmed radiographically and functionally. 4. It would be beneficial for clinical practice to introduce simple, reproducible radiographic parameters for unambiguous assessment of the effectiveness of treatment and predicting treatment outcomes; unfortunately none of the parameters we investigated were sufficiently reliable. 5. The radiographic parameters analysed in this paper are dependent on the quality of the radiological examinations performed.

A Biomechanical Study of Various Fixation Strategies for the Treatment of Clavicle Fractures Using Three-Dimensional Upper-Body Musculoskeletal Finite Element Models

Plate or nail fixations have been applied to the repair of clavicle fractures. However, it is quite difficult to fairly evaluate the different clavicle fixation techniques owing to variations in the bone anatomy, bone quality, and fracture pattern. The purpose of this study was to investigate the biomechanical performances of different fixation techniques applied to a clavicle fracture using the finite element method. A simplified single-clavicle model and a complete human upper-body skeleton model were developed in this study. Three types of plate fixations, namely, superior clavicle plate, anterior clavicle plate, and clavicle anatomic spiral fixations, and one nail fixation, a titanium elastic nail fixation, were investigated and compared. The plate fixation techniques have a better fixation stability compared to the nail fixation technique. However, the nail fixation technique shows lower bone stress and can reduce the risk of a peri-implant fracture compared to the plate fixation techniques. Increasing the number of locking screws for the clavicle plate system can reduce the implant stress. Insertion of the bone plate into the anterior site of the clavicle or a multi-plane fixation is recommended to achieve the required biomechanical performance. A plate fixation revealed a relatively better fixation stability, and a nail fixation showed a lower risk of a peri-implant fracture.

Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications.

The best strategy for implant selection in midshaft clavicular fractures (MCF) remains controversial. The present study aims to determine the optimal strategy for implant selection by comparing plate and Titanium Elastic Nail (TEN) with respect to outcomes and related complications and analyze the results based on fracture patterns. A total of 97 patients with MCF who underwent plate (48 patients) or TEN (49 patients) fixation were retrospectively reviewed. Both groups were divided into three subgroups by fracture type using the AO Foundation/Orthopaedic Trauma Association classification: simple fracture (type A), wedge fracture (type B), and multi-fragmentary fracture (type C). The observed outcome measures were bone union rate, related complications, functional scores, and patient satisfaction score. These outcomes were analyzed based on the fracture classification. Both groups demonstrated excellent union rates (p = 0.495) and similar functional scores (p > 0.05). Visual analog scale (VAS) for satisfaction was better in TEN than plate fixation (p < 0.001). In type A and B subgroups, there were no significant difference in functional scores between plate and TEN fixation (p > 0.05). In type C subgroup, however, both VAS for pain and DASH score in TEN fixation were significantly worse than in plate fixation at 2 and 6 weeks postoperatively (p < 0.05). The incidences of clavicle shortening and skin irritation are higher especially in type C subgroup of TEN fixation (p < 0.05). Patient satisfaction of TEN fixation was higher than that of plate fixation, but TEN fixation had a higher incidence of early postoperative pain and migration in type C fractures. Therefore, type A and B fractures can successfully be treated with plate or TEN fixation, but type C fractures should be treated with plate fixation.

Study of the outcome of titanium elastic nail system (Tens) in diaphyseal fractures of femur and tibia in children

Elastic stable intramedullary nailing for the treatment of Pediatric long bone fractures was introduced by Prevost and colleagues in 1979. Stabilization follows the three-point fixation principle that provides internal elastic support in the presence of cortical contact and an intact soft-tissue envelope. The technique offer several advantages including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low rate of complications. All children and adolescent patients between 5-16 years of age with diaphyseal fractures of femur and / or tibia admitted at Institute of Medical Sciences And Research, meeting the inclusion and the exclusion criteria during the study period were the subjects for the study. Totally, 30 cases were studied without any sampling procedure. Patients were followed up at 6, 12 and 24 weeks after surgery and assessed clinically and radio-logically. The final outcome is assessed as per Flynn’s criteria as excellent/ satisfactory/ poor. The final outcome was excellent in 18 (60%) cases, satisfactory in 12 (40%) cases and there were no poor outcome cases. Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric femoral and tibial fractures between the age of 5 to 16 years, with shorter operative time, lesser blood loss, lesser radiation exposure, shorter hospital stay and reasonable time to bone healing. Hence we conclude that flexible intramedullary nailing is an excellent technique for the treatment of diaphyseal fractures of the femur and tibia in children and adolescents aged 5 to 16 years.

Prospective comparative study of functional outcome of displaced midshaft clavicle fractures treated by locking plating versus minimally invasive titanium elastic nail fixation

Introduction: The clavicle is the most commonly fractured bone, which accounts for 5–10% of all fractures. More than half of these fractures are displaced.Traditionally clavicle fractures are treated non-operatively. But recent studies show higher rates of nonunion upto 15% and unsatisfactory functional outcomes despite fracture union with conservative management. Operative management of these fractures had better outcomes and a lower rate of nonunion and symptomatic mal union when compared with non-operative treatment.Commonly either plating or nailing is done for middle third clavicle fractures. It is imperative to know the complications and outcomes with both these procedures.Aim: The aim of our study is comparative analysis of outcome of Displaced middle third clavicle fractures in patients treated with plate osteosynthesis and intramedullary tens nail.Materials and Methods: This is a comparative study undertaken in the department of Orthopaedics, Meenakshi Medical College and research institute, Enathur from01/ 09/2017 to 31/08/2018. Within the period of study, 40 patients with displaced middle third clavicle fractures were operated alternatively with Plating and nailing (titanium elastic nail). We had 20 patients who were operated with Locking plate (20 Precontoured Clavicle Plate) and 20 Patients who were operated with nailing (titanium elastic nail). Outcome measures Like Blood loss, operative time, wound size, union rate and union time and Complications like infection, Nonunion, implant irritation and shortening Were compared between the two groups. Functional outcome was based on Quick DASH score.Results: The mean blood loss in plating group was 89 ml and nailing Group was 35.5ml (p

Minimally invasive retrograde insertion of elastic intramedullary nails for displaced clavicle fractures in children

To study the application and effect of retrograde titanium elastic nails fixation for the treatment of displaced clavicle fracture in children under closed reduction. From January 2014 to November 2016, 26 children with displaced fractures of the clavicle were treated by closed reduction and retrograde inserted titanium elastic nails including 14 boys and 12 girls with an average age of 9.2 years old ranging from 7 to 14 years. Time from injury to operation was 2 to 7 days with an average of 2.8 days. Visual analogue score (VAS) was used to evaluate the main complaint pain in all patients before and 2 days after operation. The Neer score of shoulder function between affected side and healthy side at 2 months after operation were compared. All the 26 children were followed up for 6 to 12 months. All cases healed well without infection, broken nails or titanium elastic nails exit complications. All children achieved anatomical reduction, good bony union, and good recovery of shoulder joint activity. The average time of removing nail was 14 to 32(16.25±2.62)weeks. The pain VAS score was significantly relieved 2 days after operation (P<0.05). At 2 months after operation, the Neer score of shoulder joint was 98.46±1.07 in affected side and 98.58±1.10 in healthy side respectively, there was no significant difference between the two groups (P>0.05). Titanium elastic intramedullary nail fixation for the treatment of displaced clavicular fracture in children has the advantages of minimal invasion, no effect on skin beauty, rapid healing of fracture, good recovery of postoperative function, simple nailing and less complications.

Titanium Elastic Nails Versus Spica Cast in Pediatric Femoral Shaft Fractures: A Systematic Review and Meta-analysis of 1012 Patients.

There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some evidence, nonetheless, we undertook a systematic meta-analysis to assess the efficacy of TEN compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old. A computer literature search of PubMed, Scopus, Web of Science, CINAHL and Cochrane Central was conducted using relevant keywords. We included clinical trials and observational studies that compared TEN versus Spica cast; Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search found 573 unique articles. After screening the abstract and relevant full text, 12 studies with a total of 1012 patients were suitable for the final analysis. In terms terms of union (in weeks), the reported effect sizes favoured the TEN group in two included studies only. Moreover, the overall standardized mean difference in sagittal (SMD -0.48, 95% CI [-0.70 to -0.26], P<0.001) and coronal angulations (SMD -0.66, 95% CI [-1.00 to -0.31], P<0.001) favored TEN fixation in management of femoral fractures younger than 16 years. The reported length of hospital stay was not consistent across studies. The overall risk ratio of malalignment (RR=0.39, 95% CI [0.27 to 0.57], P<0.001) favored the TEN as well as walking independently. Based on our analysis, TEN treatment is superior to traction and hip spica for femoral fractures in patients younger than 16 years old. Based on our analysis we recommend the use of TEN fixation in management of pediatric femoral fractures in patients younger than 16 years.

Pediatric forearm fractures with tens: freedom of movements

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A prospective analysis of a case series of diaphyseal forearm fractures in children treated with titanium elastic nails is presented. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Between 2012 and 2014, 30 children aged 5-15 years with displaced diaphyseal forearm fractures underwent titanium elastic nailing. Both bones were fractured in 25 patients, four fractured only the radius, and one experienced ulna fracture. Eleven candidates had unstable irreducible fractures, 13 had loss of reduction, and six had open fractures. Titanium elastic nails were used to stabilize the fractures. All fractures were immobilized postoperatively with an above-elbow plaster slab for 2 weeks till the swelling is completely resolved followed by encouraging range of motion exercises.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Closed reduction and TENS was successful in 20 cases, including 15 double-bone fractures and five single-bone fractures. Open reduction was completed in four fractures of both bones, and in six single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. The ROM of the forearms was evaluated using the Daruwalla grading criteria. Excellent results were reported in 96% without significant complications after a mean follow-up of 20 months.&lt;/p&gt;&lt;p class="Default"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Titanium elastic nails fixation of pediatric forearm fractures revealed several advantages, a small incision for insertion, a low rate of complications, unhindered bone healing, and good clinical and radiological results thus achieving maximum range of motion at the earliest.&lt;/p&gt;

Propriétés biomécaniques d’un clou élastique en titane sur modèle cadavérique claviculaire

BackgroundThe goal of this study was to examine biomechanical properties of titanium elastic nail fixation method that was applied to cadaveric clavicles with different thicknesses and lengths. MethodsTo test stiffness and failure load of clavicle with titanium elastic nail fixation, 12 pairs of clavicles were obtained. A short oblique fracture line (AO/OTA classification: 15-B1.2) was created at midpoint of the cadaveric bones. They were divided into four groups according to the nails with different thickness and length/diameter ratios. The fixated bones were situated on a jig that allows 3-point bending to measure stiffness and load failure. ResultsThe stiffness was measured to be mean 3.49±1.49N/mm in group 1. The stiffness for group 2 was mean 10.41±2.18N/mm, and for groups 3 and 4, the stiffness was mean 11.89±2.99N/mm and mean 24.44±4.86N/mm, respectively. When analyzed with statistics, group 1 had significant differences from groups 2 (P<0.006), 3 (P<0.001), and 4 (P<0.000), and group 4 also had statistical significances from the rest of the groups (P<0.000). ConclusionsFor 2.5mm titanium elastic nail, it is necessary to make fixation with a titanium elastic nail that is longer than 3 diameter lengths, and a length that is longer than and equal to 3 diameter length titanium elastic nail was required for 3.5mm titanium elastic nail to provide appropriate stiffness for firm fixation. Also, variances in both thickness and length have shown a similar effect. Study designCadaveric study.

Biomechanical properties of titanium elastic nail applied to a cadaveric clavicle model

BackgroundThe goal of this study was to examine biomechanical properties of titanium elastic nail fixation method that was applied to cadaveric clavicles with different thicknesses and lengths. MethodsTo test stiffness and failure load of clavicle with titanium elastic nail fixation, 12 pairs of clavicles were obtained. A short oblique fracture line (AO/OTA classification: 15-B1.2) was created at midpoint of the cadaveric bones. They were divided into four groups according to the nails with different thickness and length/diameter ratios. The fixated bones were situated on a jig that allows 3-point bending to measure stiffness and load failure. ResultsThe stiffness was measured to be mean 3.49±1.49N/mm in group 1. The stiffness for group 2 was mean 10.41±2.18N/mm, and for groups 3 and 4, the stiffness was mean 11.89±2.99N/mm and mean 24.44±4.86N/mm, respectively. When analyzed with statistics, group 1 had significant differences from groups 2 (P<0.006), 3 (P<0.001), and 4 (P<0.000), and group 4 also had statistical significances from rest of the groups (P<0.000). ConclusionsFor 2.5mm titanium elastic nail, it is necessary to make fixation with a titanium elastic nail that is longer than 3 diameter lengths, and length that is longer than and equal to 3 diameter length titanium elastic nail was required for 3.5mm titanium elastic nail to provide appropriate stiffness for firm fixation. Also, variances in both thickness and length have shown a similar effect. Study designCadaveric study.

Titanium Elastic Nail versus plate fixation of displaced midshaft clavicle fractures: A retrospective comparison study

This study has two purposes: (1) to compare the clinical results between the Titanium Elastic Nail (TEN) and plate fixation of the displaced midshaft clavicle fracture; and (2) to demonstrate the relationship between length shortening and functional outcome after TEN fixation, especially in the comminuted fracture pattern. A retrospective, case-controlled study was conducted and 55 patients were included in our study: 25 in the TEN fixation group (TEN group) and 30 in the plate fixation group (plate group). All patients were classified into four subgroups: simple fracture in the TEN group (ST; n = 13), simple fracture in the plate group (SP; n = 15), comminuted fracture in the TEN group (CT; n = 12), and comminuted fracture in the plate group (CP; n = 15). Wound size was significantly smaller in the TEN group (p < 0.001). The injured clavicular length after fracture healing was significantly shorter in the TEN group (p = 0.036). There was no significant difference in the mean Constant and DASH scores. Injured clavicle shortening was significantly larger in the CT subgroup (p = 0.018). However, there was no statistically significant difference in Constant score and DASH score while comparing the CT subgroup to other subgroups. Although TEN fixation may lead to a higher degree of length shortening after bony union especially in cases of comminuted fracture pattern, no statistically significant difference was observed in objective functional results as compared to other subgroups. Therefore, TEN can be used to fix a displaced midshaft clavicle fracture even in cases of comminuted fracture pattern, which overall is an effective and less surgically invasive procedure.

Titanium Elastic Nail (TEN) versus Reconstruction Plate Repair of Midshaft Clavicular Fractures: A Finite Element Study.

BackgroundThe biomechanical characteristics of midshaft clavicular fractures treated with titanium elastic nail (TEN) is unclear. This study aimed to present a biomechanical finite element analysis of biomechanical characteristics involved in TEN fixation and reconstruction plate fixation for midshaft clavicular fractures.MethodsFinite element models of the intact clavicle and of midshaft clavicular fractures fixed with TEN and with a reconstruction plate were built. The distal clavicle displacement, peak stress, and stress distribution on the 3 finite element models were calculated under the axial compression and cantilever bending.ResultsIn both loading configurations, TEN generated the highest displacement of the distal clavicle, followed by the intact clavicle and the reconstruction plate. TEN showed higher peak bone and implant stresses, and is more likely to fail in both loading configurations compared with the reconstruction plate. TEN led to a stress distribution similar to that of the intact clavicle in both loading configurations, whereas the stress distribution with the reconstruction plate was nonphysiological in cantilever bending.ConclusionsTEN is generally preferable for treating simple displaced fractures of the midshaft clavicle, because it showed a stress distribution similar to the intact clavicle. However, TEN provides less stability, and excessive exercise of and weight bearing on the ipsilateral shoulder should be avoided in the early postoperative period. Fixation with a reconstruction plate was more stable but showed obvious stress shielding. Therefore, for patients with a demand for early return to activity, reconstruction plate fixation may be preferred.