Functional outcome of Midshaft Clavicle fracture treated with Titanium Elastic Nail System: Short term prospective outcome analysis

Vivekanandan, R (2013) Functional outcome of Midshaft Clavicle fracture treated with Titanium Elastic Nail System: Short term prospective outcome analysis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Clavicle fractures are common in children and young adults, commonly occurring in persons younger than 25 years. Clavicle becomes the most common site of injury because of its subcutaneous superficial location, thin midshaft, and the forces transmitted across it. The mechanism of injury is usually forceful fall with outstretched hand, which occurs commonly during contact sports. Clavicle fractures comprise about 30 -40% of all shoulder girdle injuries. Midshaft clavicular fractures accounts for 80-85% of them Traditional view that all clavicle fractures heal with good functional outcome no longer holds good. Midclavicular fractures are generally managed conservatively, e.g. with a figure-of-eight-bandage. Imminent perforation of the skin, impending or existing neurovascular compromise and the floating shoulder and gross displacement of fracture fragments were absolute indications for operative treatment. A number of publications described the technique of minimally invasive osteosynthesis using elastic stable intramedullary nails (ESIN). Early functional recovery and a rapid return to daily activities and low complication rate have been reported as advantages. AIM: The aim of the study is 1. To analyse the functional outcome of mid-shaft clavicle fractures treated with flexible intramedullary nails in our Institution. 2. To study the complications of the surgery 3. To study the duration of bony union following fixation with intra medullary nailing. MATERIALS AND METHODS: This is a prospective study carried out from May 2010 to December 2012 at the Institute of Orthopaedics and Traumatology, Rajiv Gandhi Govt. General Hospital, Madras Medical College Chennai. 20 patients admitted with displaced midshaft clavicular fractures during this period were treated with Titanium Elastic Nail and were studied for the functional outcome, complications and fracture union. Inclusion Criteria: 1. Age above 15years, 2. OTA type A and B fractures, 3. Displaced closed clavicle fractures, 4. Fractures with imminent skin perforation, 5. Floating shoulder injuries, 6. Polytrauma with ipsilateral rib fractures. Exclusion Criteria: 1. Age less than 15 years, 2. Compound fractures, 3. OTA type C fractures, 4. Lateral and medial end clavicle fractures, 5. Uncooperative patient for post operative rehabilitation. RESULTS: The present study consists of 20 cases of displaced mid-shaft clavicle fractures who qualified for the study according to our inclusion criteria. They were treated with Titanium Elastic Nail between May 2010 to May 2012. No potential candidate refused to enter the study by preferring nonoperative treatment. All the patients were available for follow-up and they were followed every 4 weeks for a period of 6 months . Results were analyzed both clinically and radiologically. Of the 20 patients 12 patients (60%) fracture occurred due to road traffic accident,4 (20%) patients sustained fracture due to indirect injury, fall on outstretched hand and 4patients (20%) due to fall from height. In all the patients fractures were closed type. CONCLUSION: The data of this study shows that the treatment of mid-shaft clavicle fractures treated with titanium elastic intramedullary nailing results in excellent functional outcome. This technique provides high bone union rate, good functional outcome, early shoulder pain relief and early functional recovery obtained with minimal complications. This procedure is less invasive and can be performed with small incision when compared to plate fixation. But in communited fractures this can lead to telescoping and fracture heals with shortening. This is procedure is best suitable only for non communited midshaft clavicle fracture. Randomized controlled trials with adequate follow-up are required o determine the optimal surgical method to treat mid clavicular fractures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome ; Midshaft Clavicle fracture ; Titanium Elastic Nail System ; Short term prospective outcome analysis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 08:39
Last Modified: 16 Sep 2017 08:39

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