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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2017 | Research article

An intramedullary Echidna pin for fixation of comminuted clavicle fractures: a biomechanical study

Authors: David Ackland, Ian Griggs, Patrick Hislop, Wen Wu, Minoo Patel, Martin Richardson

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2017

Abstract

Background

Intramedullary fixation of comminuted mid-shaft clavicle fractures has traditionally been employed with satisfactory clinical outcomes; however, pins with smooth surfaces may protrude from the bone and are prone to migration, while some threaded pins are difficult to remove post-operatively. The aim of this proof-of-concept study was to develop and evaluate the biomechanical strength of a novel intramedullary Echidna pin device designed to maintain fracture reduction, resist migration and facilitate ease of post-operative removal.

Methods

Thirty human clavicle specimens were harvested and fractured in a comminuted mid-shaft butterfly configuration. Each specimen was randomly allocated to three surgical repair groups including intramedullary fixation using the Echidna pin and Herbert Cannulated Bone Screw System, as well as plate fixation using bi-cortical locking screws. Using a biomechanical testing apparatus, construct bending and torsional stiffness were measured, as well as ultimate bending strength.

Results

There was no significant difference in torsional stiffness and ultimate bending moment between the Echidna pin and Herbert screw repair constructs (p > 0.05); however, the Echidna pin construct demonstrated a significantly greater bending stiffness compared to that of the Herbert screw construct (mean difference 0.55 Nm/deg., p = 0.001). The plate construct demonstrated significantly greater torsional stiffness, bending stiffness and ultimate bending moment compared to those of the Herbert screw and Echidna pin (p < 0.05).

Conclusions

An intramedullary Echidna pin device was designed to stabilize comminuted fractures of the clavicle, maintain fracture compression and provide ease of removal post-operatively. Since the results suggest equivalent or superior torsional and bending stability in the Echidna pin compared to that of the Herbert screw, the Echidna pin concept may represent an alternative fixation device to conventional intramedullary screws, nails and pins; however, superior plating using bi-cortical locking screws provides substantially higher construct structural rigidity than intramedullary devices, and may therefore be useful in cases of osteoporotic bone, or where high fracture stability is required.

Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.CrossRef

Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127–32.

Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop. 2005;76(4):496–502.CrossRefPubMed

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-A(7):1359–65.CrossRefPubMed

Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79(4):537–9.CrossRefPubMed

Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma. 1998;12(8):572–6.CrossRefPubMed

Bernstein J. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2007;89(8):1866. author reply 1866-7CrossRefPubMed

Lee YS, Huang HL, Lo TY, Hsieh YF, Huang CR. Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation. Int Orthop. 2008;32(4):541–5.CrossRefPubMed

Kabak S, Halici M, Tuncel M, Avsarogullari L, Karaoglu S. Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques. J Shoulder Elb Surg. 2004;13(4):396–403.CrossRef

10.

Clitherow HD, Bain GI. Major neurovascular complications of clavicle fracture surgery. J Shoulder Elb Surg. 2015;7:3–12.CrossRef

11.

Leroux T, Wasserstein D, Henry P, Khoshbin A, Dwyer T, Ogilvie-Harris D, Mahomed N, Veillette C. Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study in Ontario, Canada. J Bone Joint Surg Am. 2014;96(13):1119–25.CrossRefPubMed

12.

Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop. 2012;36(3):579–85.CrossRefPubMed

13.

Frigg A, Rillmann P, Perren T, Gerber M, Ryf C. Intramedullary nailing of clavicular midshaft fractures with the titanium elastic nail: problems and complications. Am J Sports Med. 2009;37(2):352–9.CrossRefPubMed

14.

Hamman D, Lindsey D, Dragoo J. Biomechanical analysis of bicortical versus unicortical locked plating of mid-clavicular fractures. Arch Orthop Trauma Surg. 2011;131(6):773–8.CrossRefPubMed

15.

Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elb Surg. 2010;19(6):783–9.CrossRef

16.

Ring D, Holovacs T. Brachial plexus palsy after intramedullary fixation of a clavicular fracture. A report of three cases. J Bone Joint Surg Am. 2005;87(8):1834–7.CrossRefPubMed

17.

Muller MC, Burger C, Florczyk A, Striepens N, Rangger C. Elastic titanium nails in minimally invasive osteosynthesis for mid-clavicular fractures. Chirurg. 2007;78(4):349–55.CrossRefPubMed

18.

Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res. 2003;408:279–85.CrossRef

19.

Persiani P, Molayem I, Villani C, Cadilhac C, Glorion C. Surgical treatment of congenital pseudarthrosis of the clavicle: a report on 17 cases. Acta Orthop Belg. 2008;74(2):161–6.PubMed

20.

Ngarmukos C, Parkpian V, Patradul A. Fixation of fractures of the midshaft of the clavicle with Kirschner wires. Results in 108 patients. J Bone Joint Surg Br. 1998;80(1):106–8.CrossRefPubMed

21.

Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ). 2009;38(7):341–5.

22.

Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72(8):1262–7.CrossRefPubMed

23.

Naidoo P. Migration of a Kirschner wire from the clavicle into the abdominal aorta. Arch Emerg Med. 1991;8(4):292–5.CrossRefPubMedPubMedCentral

24.

Proubasta IR, Itarte JP, Lamas CG, Caceres E. Midshaft clavicular non-unions treated with the Herbert cannulated bone screw. J Orthop Surg(Hong Kong). 2004;12(1):71–5.CrossRef

25.

Proubasta IR, Itarte JP, De Frutos AG, Caceres EP. Treatment of posttraumatic midshaft clavicular pseudarthrosis with the Herbert cannulated bone screw and autologous bone grafting. A case report. Bull Hosp Jt Dis. 1999;58(4):217–9.PubMed

26.

Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A. Biomechanical comparison of fixation techniques in midshaft clavicular fractures. J Orthop Trauma. 2011;25(5):272–8.CrossRefPubMed

27.

Golish SR, Oliviero JA, Francke EI, Miller MD. A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res. 2008;3:28.CrossRefPubMedPubMedCentral

28.

Rawlings M, Knox D, Patel M, Ackland D. A hybrid approach to mid-shaft clavicle fixation. Injury. 2016;47(4):893–8.CrossRefPubMed

29.

Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A. Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma. 2008;22(4):241–7.CrossRefPubMed

30.

Robertson C, Celestre P, Mahar A, Schwartz A. Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between nonlocked and locked plates in two different positions. J Shoulder Elb Surg. 2009;18(2):204–9.CrossRef

31.

Liu HH, Chang CH, Chia WT, Chen CH, Tarng YW, Wong CY. Comparison of plates versus intramedullary nails for fixation of displaced midshaft clavicular fractures. J Trauma. 2010;69(6):E82–7.CrossRefPubMed

32.

ST D, Day M, Dent C, Williams R, Evans R. Treatment of mid-shaft clavicle fractures: a comparative study. Int J Shoulder Surg. 2009;3(2):23–7.CrossRef

33.

Kernek CB, Robb JA. External callus formation of closed femoral shaft fractures treated by medullary fixation. Orthopedics. 1986;9(1):45–51.PubMed

34.

Zeng L, Wei H, Liu Y, Zhang W, Pan Y, Zhang W, Zhang C, Zeng B, Chen Y. Titanium elastic nail (TEN) versus reconstruction plate repair of midshaft clavicular fractures: a finite element study. PLoS One. 2015;10(5):e0126131.CrossRefPubMedPubMedCentral

35.

Oroko PK, Buchan M, Winkler A, Kelly IG. Does shortening matter after clavicular fractures? Bull Hosp Jt Dis. 1999;58(1):6–8.PubMed

36.

Mudd CD, Quigley KJ, Gross LB. Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood clavicle pin. Clin Orthop Relat Res. 2011;469(12):3364–70.CrossRefPubMedPubMedCentral

Title: An intramedullary Echidna pin for fixation of comminuted clavicle fractures: a biomechanical study
Authors: David Ackland
Ian Griggs
Patrick Hislop
Wen Wu
Minoo Patel
Martin Richardson
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2017
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-017-0623-y

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Springer Medicine

An intramedullary Echidna pin for fixation of comminuted clavicle fractures: a biomechanical study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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