Intramedullary nailing of displaced midshaft clavicle fractures using a TEN with end cap: issues encountered

The purpose of this study was to describe our experience with a possible solution for implant- related irritation after intramedullary nailing of displaced midshaft clavicle fractures: the end cap. Ten patients with a displaced midshaft clavicle fracture were treated with intramedullary nailing and an end cap in 2013. Patients were followed in the outpatient clinic until fracture union. In 2015 patients were contacted again. Prospectively collected data included shoulder function and complications. The median follow-up time was 28.5 months (between 27 and 30 months). No patients were lost to follow- up. QuickDASH scores were 18.2, 9.1 and 2.3 after 6 weeks, 3 month and latest follow-up respectively. Nine patients (90%) had some type of implant-related complication. In three of these patients implant removal was required before union. One implant failure occurred which required major revision surgery using plate fixation. In conclusion, because in 70% of the patients the implant-related irritation was directly caused by the end cap, we believe end caps should not be used after intramedullary nailing for displaced midshaft clavicle fractures.