[Intramedullary Stabilisation of Displaced Midshaft Clavicular Fractures in Heavy Workers and Complex Fracture...

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomechanics

Background:

• Plate osteosynthesis (PO) is recommended for complex displaced midshaft clavicular fractures (DMCF) and for heavy workers.
• Intramedullary stabilization (IMS) offers an alternative treatment for DMCF.
• This study compares the duration of inability to work (DIW) after IMS for DMCF with existing data for conservative treatment and PO.

Purpose of the Study:

• To evaluate the duration of inability to work (DIW) following intramedullary stabilization (IMS) for displaced midshaft clavicular fractures (DMCF).
• To compare DIW after IMS with published data for conservative treatment and plate osteosynthesis (PO).
• To investigate the influence of fracture complexity, physical workload, and postoperative physiotherapy on DIW after IMS for DMCF.

Main Methods:

• A cohort of 58 patients with closed unilateral DMCF treated with open reduction and IMS (Titanium Elastic Nail) was studied between 09/2009 and 07/2015.
• Duration of inability to work (DIW) was recorded in days, from accident to full work resumption.
• Patients were classified by physical workload (REFA criteria) and fracture pattern (simple vs. complex); postoperative physiotherapy was also assessed.

Main Results:

• Median DIW was 39.86 days, independent of physical workload.
• Patients with low physical workload (REFA 0-1) had a shorter DIW (32.48 days) than those with high physical workload (REFA 2-4) (49.6 days) (p=0.02).
• Fracture type did not significantly influence DIW (p=0.85), and patients without postoperative physiotherapy had shorter DIW (30.5 days) than those with PT (49.89 days) (p=0.021).

Conclusions:

• DIW after IMS for DMCF is not dependent on fracture complexity.
• Heavy workers experience a significantly longer DIW after IMS compared to light physical workers.
• IMS allows immediate pain-adapted shoulder movement up to 90° abduction/flexion, irrespective of fracture type; additional physiotherapy may prolong DIW.