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European Journal of Trauma and Emergency Surgery

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01-08-2018 | Original Article

Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures

Authors: M. H. J. Hulsmans, M. van Heijl, H. Frima, O. A. J. van der Meijden, H. R. van den Berg, A. H. van der Veen, A. C. Gunning, R. M. Houwert, E. J. M. M. Verleisdonk

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2018

Abstract

Purpose

Implant-related irritation is a technique-specific complication seen in a substantial number of patients treated with intramedullary nailing for clavicle fractures. The purpose of this study was to identify predictors for developing implant-related irritation in patients with displaced midshaft clavicle fractures treated with elastic stable intramedullary nailing.

Methods

A retrospective analysis of the surgical database in two level 2 trauma centers was performed. Patients who underwent intramedullary nailing for displaced midshaft clavicle fractures between 2005 and 2012 in the first hospital were included. Age, gender, fracture comminution and fracture location were assessed as possible predictors for developing irritation using multivariate logistic regression analysis. These predictors were externally validated using data of patients treated in another hospital.

Results

Eighty-one patients were included in initial analysis. In the multivariate analysis, comminuted fractures in comparison to non-comminuted fractures (72 vs. 38%, p = 0.027) and fracture location (p < 0.001) were significantly associated with the development of implant-related irritation. In particular, lateral diaphyseal fractures caused irritation compared to fractures on the medial side of the cut-off point (88 vs. 26%). External validation of these predictors in 48 additional patients treated in another hospital showed a similar predictive value of the model and a good fit.

Conclusion

Comminuted and lateral diaphyseal fractures were found to be statistically significant and independent predictors for developing implant-related irritation. We, therefore, believe that intramedullary nailing might not be suitable for these types of fractures. Future studies are needed to determine whether alternative surgical techniques or implants would be more suitable for these specific types of fractures.

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Title: Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures
Authors: M. H. J. Hulsmans
M. van Heijl
H. Frima
O. A. J. van der Meijden
H. R. van den Berg
A. H. van der Veen
A. C. Gunning
R. M. Houwert
E. J. M. M. Verleisdonk
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 4/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-017-0848-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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