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European Journal of Trauma and Emergency Surgery

Published in:

01-02-2018 | Original Article

End cap versus no end cap in intramedullary nailing for displaced midshaft clavicle fractures: influence on implant-related irritation

Authors: H. Frima, M. H. J. Hulsmans, R. M. Houwert, U. Ahmed Ali, E. J. M. M. Verleisdonk, C. Sommer, M. van Heijl

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2018

Abstract

Purpose

Implant-related irritation at the entry site is a known disadvantage of intramedullary nailing for clavicle fractures. The purpose of this study was to compare implant-related irritation rates of intramedullary nailing with or without an end cap for displaced midshaft clavicle fractures.

Methods

Two cohorts of patients treated with intramedullary nailing with or without an end cap were matched and compared. Primary outcome was patient-reported implant-related irritation. Secondary outcome parameters were complications.

Results

A total of 34 patients with an end cap were matched with 68 patients without an end cap. There was no difference in implant-related irritation (41 versus 53%, P = 0.26). Significantly more minor revisions were observed in the group without an end cap (15 versus 0%, P = 0.03). For complications requiring major revision surgery, significantly more implant failures were observed in the end cap group (12 versus 2%, P = 0.04). Regardless of their treatment, patients with complex fractures (AO/OTA B2–B3) reported significantly more medial irritation compared to patients with simple fractures (AO/OTA B1)(P = 0.02).

Conclusion

The use of an end cap after intramedullary nailing for displaced midshaft clavicle fractures did not result in lower patient-reported irritation rates. Although less minor revisions were observed, more major revisions were reported in the end cap group. Based on the results of this study, no end caps should be used after intramedullary nailing for displaced midshaft clavicle fractures. However, careful selection of simple fractures might be effective in reducing implant-related problems after intramedullary nailing.

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Title: End cap versus no end cap in intramedullary nailing for displaced midshaft clavicle fractures: influence on implant-related irritation
Authors: H. Frima
M. H. J. Hulsmans
R. M. Houwert
U. Ahmed Ali
E. J. M. M. Verleisdonk
C. Sommer
M. van Heijl
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-017-0784-8

At a glance: The STEP trials

Springer Medicine

End cap versus no end cap in intramedullary nailing for displaced midshaft clavicle fractures: influence on implant-related irritation

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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