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SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

Abstract

BITHREY, JW  and  VAN DER MERWE, JF. Outcomes of treatment of displaced midshaft clavicle fractures in adolescents using titanium elastic nails. SA orthop. j. [online]. 2017, vol.16, n.3, pp.55-61. ISSN 2309-8309.  http://dx.doi.org/10.17159/2309-8309/2017/v16n3a8.

BACKGROUND: Literature on the functional outcomes following the treatment of closed, displaced midshaft clavicle fractures in adolescents is fairly limited. These fractures have traditionally been treated non-operatively; however, recent literature in adults shows improved outcomes with operative treatment, and it has been suggested that these results may translate to adolescents. STUDY OBJECTIVE: To assess the effectiveness of titanium elastic nailing in the treatment of displaced midshaft clavicle fractures in adolescents. METHODS: Adolescent patients (age 13 to 17 years) with closed, displaced midshaft clavicle fractures sustained between 2008 and 2015, were treated operatively with a titanium elastic nail inserted in an unreamed fashion from the sternal end of the clavicle by a single surgeon. Post-operatively, patients were immobilised in a sling for six weeks and attended scheduled follow-up visits at two, six and 12 weeks. The nail was removed from 12 weeks onwards in all cases. All patients were assessed by the surgeon with regard to the radiological outcome, Constant shoulder score, scar quality and complications RESULTS: Fifteen patients, 12 males and three females with a mean age of 14.9 years, were assessed. Fourteen patients went on to complete union by 12 weeks and the remaining one united by 20 weeks post-surgery. The difference in Constant shoulder scores between the affected and unaffected shoulders for 14 patients was below 11 at 12 weeks' follow-up and all patients were satisfied with their scar after 12 weeks. Two patients developed complications - one an iatrogenic perforation of the posterior cortex of the lateral fragment and one a haematoma after re-injury. CONCLUSION: Operative treatment with a titanium elastic nail is a safe, minimally invasive and reliable treatment method for displaced, uncomminuted midshaft clavicle fractures in adolescents. Level of evidence: Case series; Level IV evidence.

Keywords : clavicle; fracture; adolescent; intramedullary; nailing.

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