Top

Clinical Orthopaedics and Related Research®

Published in:

01-12-2011 | Symposium: Fractures of the Shoulder Girdle

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Authors: Christopher D. Mudd, MD, Kevin J. Quigley, MD, Lyndon B. Gross, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2011

Abstract

Background

Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing.

Questions/purposes

We asked the following questions: (1) Does use of the Rockwood Clavicle Pin (DePuy Orthopaedics Inc, Warsaw, IN) predispose patients to soft tissue complications requiring additional surgery or a high infection risk? (2) Does the Rockwood Clavicle Pin provide a truly minimally invasive insertion technique and reliable fracture fixation?

Patients and Methods

We retrospectively evaluated 18 patients (mean age, 31 years) who sustained a closed midshaft fracture of the clavicle treated with open intramedullary nailing with a Rockwood Clavicle Pin. We determined the incidence of complications and rate of fracture healing.

Results

Fourteen complications occurred in 10 patients. Five patients experienced a complication with fracture healing, including three nonunions. Nine patients experienced complications relating to soft tissue, including infection, skin necrosis, or posterior pain from pin prominence.

Conclusions

The Rockwood Clavicle Pin remains a historically relevant method of clavicle fixation. However, due to an unacceptably high rate of nonunion, repeat operation, and soft tissue complications, we do not recommend this device for treating middiaphyseal clavicle fractures.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Boehme D, Curtis RJ Jr, DeHaan JT, Kay SP, Young DC, Rockwood CA Jr. Non-union of fractures of the mid-shaft of the clavicle: treatment with a modified Hagie intramedullary pin and autogenous bone grafting. J Bone Joint Surg Am. 1991;73:1219–1226.PubMed

Brinker MR, Edwards TB, O’Connor DP. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2005;87:676–677; author reply 677.PubMed

Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicle fractures: a multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1–10.CrossRef

Corrales LA, Morshed S, Bhandari M. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90:1862–1868.PubMedCrossRef

Fracture and Dislocation Compendium: Orthopaedic Trauma Association for Coding and Classification. J Orthop Trauma. 1996:(10 Suppl 1):v–ix,1–154.

Grassi FA, Tajana MS, D’Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma. 2001;50:1096–1100.PubMedCrossRef

Hill JM, McGwire MH, Crosby LA. Closed treatment of displaced middle-third clavicle fractures gives poor results. J Bone Joint Surg Br. 1997;79:537–539.PubMedCrossRef

Jubel A, Andermahr J, Bergmann H, Prokop A, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures in athletes. Br J Sports Med. 2003;37:480–484.PubMedCrossRef

Jupiter JB, Leffert RD. Non-unions of the clavicle. J Bone Joint Surg Am. 1987;69:753–760.PubMed

10.

Lazarides S, Zafiropoulos G, Tydfil M. Conservative treatment of fractures of the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006;15:191–194.PubMedCrossRef

11.

McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35–40.PubMedCrossRef

12.

Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006–1011.PubMed

13.

Nordqvist A, Peterson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127–132.PubMed

14.

Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures: a prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31:353–358.PubMedCrossRef

15.

Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11:452–456.PubMedCrossRef

16.

Renfree T, Conrad B, Wright T. Biomechanical comparison of contemporary clavicle fixation devices. J Hand Surg Am. 2010;35:639–644.PubMedCrossRef

17.

Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86:1359–1365.PubMed

18.

Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968;58:29–42.PubMedCrossRef

19.

Sankarankutty M, Turner BW. Fractures of the clavicle. Injury. 1975;7:101–106.PubMedCrossRef

20.

Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:280–284.PubMedCrossRef

Title: Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin
Authors: Christopher D. Mudd, MD
Kevin J. Quigley, MD
Lyndon B. Gross, MD, PhD
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1867-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 12/2011

Reply to Letter to the Editor: The Effect of Long-term Alendronate Treatment on Cortical Thickness of the Proximal Femur

Cannulated Screw and Cable are Superior to Modified Tension Band in the Treatment of Transverse Patella Fractures

Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique

A Reliable Radiographic Measurement Technique for Extra-articular Scapular Fractures

Improvement in Reflux Gastroesophagitis in a Patient with Spinal Muscular Atrophy after Surgical Correction of Kyphoscoliosis: A Case Report

Acknowledgment