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Failure of a new intramedullary device in fixation of clavicle fractures: a report of two cases and review of the literature

2011; Elsevier BV; Volume: 20; Issue: 4 Linguagem: Inglês

10.1016/j.jse.2010.11.032

1532-6500

Daniel K. Palmer, Adeel Husain, Wesley P. Phipatanakul, Montri D. Wongworawat,

Shoulder Injury and Treatment

Operative fixation is gaining popularity in the treatment of displaced midshaft clavicle fractures. 13 Hill J.M. McGuire M.H. Crosby L.A. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997; 79: 537-539https://doi.org/10.1302/0301-620X.79B4.7529 Crossref PubMed Scopus (568) Google Scholar , 20 McKee M.D. Pedersen E.M. Jones C. Stephen D.J. Kreder H.J. Schemitsch E.H. et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006; 88: 35-40https://doi.org/10.2106/JBJS.D.02795 Crossref PubMed Scopus (345) Google Scholar , 21 McKee M.D. Wild L.M. Schemitsch E.H. Midshaft malunions of the clavicle. J Bone Joint Surg Am. 2003; 85: 790-797 Crossref PubMed Scopus (242) Google Scholar Plates have traditionally been used in the surgical stabilization of these fractures. 2 Bostman O. Manninen M. Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997; 43: 778-783https://doi.org/10.1097/00005373-199711000-00008 Crossref PubMed Scopus (215) Google Scholar , 4 Canadian Orthopaedic Trauma SocietyNonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007; 89: 1-10https://doi.org/10.2106/JBJS.F.00020 Crossref Scopus (639) Google Scholar , 6 Celestre P. Roberston C. Mahar A. Oka R. Meunier M. Schwartz A. Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability?. J Orthop Trauma. 2008; 22: 241-247https://doi.org/10.1097/BOT.0b013e31816c7bac Crossref PubMed Scopus (110) Google Scholar , 10 Golish S.R. Oliviero J.A. Francke E.I. Miller M.D. A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res. 2008; 3: 28https://doi.org/10.1186/1749-799X-3-28 Crossref PubMed Scopus (74) Google Scholar , 14 Iannotti M.R. Crosby L.A. Stafford P. Grayson G. Goulet R. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg. 2002; 11: 457-462https://doi.org/10.1067/mse.2002.125805 Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar , 18 Khan L.A. Bradnock T.J. Scott C. Robinson C.M. Fractures of the clavicle. J Bone Joint Surg Am. 2009; 91: 447-460https://doi.org/10.2106/JBJS.H.00034 Crossref PubMed Scopus (83) Google Scholar , 34 Wick M. Muller E.J. Kollig E. Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001; 121: 207-211https://doi.org/10.1007/s004020000202 Crossref PubMed Scopus (109) Google Scholar External fixators are rarely used, mainly being used in cases of open clavicular fracture or septic nonunion. 30 Schuind F. Pay-Pay E. Andrianne Y. Donkerwolcke M. Rasquin C. Burny F. External fixation of the clavicle for fracture or non-union in adults. J Bone Joint Surg Am. 1988; 70: 692-695 PubMed Google Scholar Intramedullary devices behave as internal splints that maintain alignment of the fracture without rigid fixation. They are theoretically advantageous when compared with plate/screw devices because they entail minimal soft-tissue dissection and periosteal stripping, shorter hospital stays, cosmetic surgical exposure, and no skin prominence at the fracture site, and they avoid stress shielding. 17 Kettler M. Schieker M. Braunstein V. Konig M. Mutschler W. Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: technique and results in 87 patients. Acta Orthop. 2007; 78: 424-429https://doi.org/10.1080/17453670710014022 Crossref PubMed Scopus (65) Google Scholar , 18 Khan L.A. Bradnock T.J. Scott C. Robinson C.M. Fractures of the clavicle. J Bone Joint Surg Am. 2009; 91: 447-460https://doi.org/10.2106/JBJS.H.00034 Crossref PubMed Scopus (83) Google Scholar , 19 Liu H.H. Chang C.H. Chia W.T. Chen C.H. Tarng Y.W. Wong C.Y. Comparison of plates versus intramedullary nails for fixation of displaced midshaft clavicular fractures. J Trauma. 2010; 69: E82-E87https://doi.org/10.1097/TA.0b013e3181e03d81 Crossref PubMed Scopus (67) Google Scholar Intramedullary devices are now becoming streamlined to the anatomic specificities of the clavicle. 1 Andermahr J. Jubel A. Elsner A. Johann J. Prokop A. Rehm K.E. et al. Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures. Clin Anat. 2007; 20: 48-56https://doi.org/10.1002/ca.20269 Crossref PubMed Scopus (73) Google Scholar , 5 Capicotto P.N. Heiple K.G. Wilbur J.H. Midshaft clavicle nonunions treated with intramedullary Steinman pin fixation and onlay bone graft. J Orthop Trauma. 1994; 8: 88-93https://doi.org/10.1097/00005131-199404000-00002 Crossref PubMed Scopus (44) Google Scholar , 10 Golish S.R. Oliviero J.A. Francke E.I. Miller M.D. A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res. 2008; 3: 28https://doi.org/10.1186/1749-799X-3-28 Crossref PubMed Scopus (74) Google Scholar , 15 Jubel A. Andermahr J. Schiffer G. Tsironis K. Rehm K.E. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res. 2003; : 279-285https://doi.org/10.1097/00003086-200303000-00037 Crossref PubMed Scopus (101) Google Scholar , 17 Kettler M. Schieker M. Braunstein V. Konig M. Mutschler W. Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: technique and results in 87 patients. Acta Orthop. 2007; 78: 424-429https://doi.org/10.1080/17453670710014022 Crossref PubMed Scopus (65) Google Scholar , 18 Khan L.A. Bradnock T.J. Scott C. Robinson C.M. Fractures of the clavicle. J Bone Joint Surg Am. 2009; 91: 447-460https://doi.org/10.2106/JBJS.H.00034 Crossref PubMed Scopus (83) Google Scholar , 32 Strauss E.J. Egol K.A. France M.A. Koval K.J. Zuckerman J.D. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007; 16: 280-284https://doi.org/10.1016/j.jse.2006.08.012 Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar The sigmoid shape of the clavicle dictates that intramedullary clavicle pins must be narrow and flexible enough to be installed through the curved medullary canal. 29 Rowe C.R. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968; 58: 29-42https://doi.org/10.1097/00003086-196805000-00006 Crossref PubMed Google Scholar , 33 Thumroj E. Kosuwon W. Kamanarong K. Anatomic safe zone of pin insertion point for distal clavicle fixation. J Med Assoc Thai. 2005; 88: 1551-1556 PubMed Google Scholar