S-shaped titanium endomedullary nail reduces telescoping of comminuted midshaft clavicular fractures

The surgical treatment of displaced midshaft clavicular fractures (DMCF) is clinically relevant and a much discussed topic. The axial stability of DMCF after intramedullary nailing (IMN) is still a matter of debate.

Our objective was to present a modification of IMN of DMCF with S-shaped titanium endomedullary nail (TEN) and determine fracture telescoping from day one after surgery to the time of fracture healing.

In a prospective analytic cohort study over a 6-year period (2012-2017) at a Level II trauma care centre, a total of 128 patients with DMCF were included and classified according to the AO/OTA classification system. Group I was AO/OTA type 15.2A/15.2B (N = 68) and group II was AO/OTA type 15.2C (N = 60). After a modified open stabilization technique of each DMCF with IMN (S-shaped TEN), the dynamics of radiological assessed telescoping until union and rate of surgical adverse events were measured. Significance was assumed for p < 0.05.

One day after surgery, fractured clavicles were lengthened slightly in both groups compared to the unfractured clavicules (group I: 1.2%; group II: 0.9%). After osseus consolidation, the fractured clavicules were significantly shortened in both groups (group I: - 2.9%; group II: - 3.6%). Measurement of the clavicular shortening at one day postsurgically and at consolidation revealed a mean telescoping of - 3.99% in group I and of - 4.6% in group II. The difference between the two groups was not significant (P = 0.522). The overall rate of major surgical adverse events was 2.3%.

The proposed operative technique of IMN (stabilization of the DMCF with a long, S-shaped, tight-fitting TEN) provides enough axial stability to prevent significant telescoping of the comminuted fractures. The rate of nonunion is low and the overall rate of major adverse events is similar to the reported events after plate fixation in the literature.