Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures

The purpose of this report was to evaluate patient outcomes after treatment of acute midshaft clavicle fractures with an intramedullary Hagie pin, including clinical results and the incidence of postoperative complications. Between 1993 and 2003, 16 patients who underwent intramedullary Hagie pin fixation of a midshaft clavicle fracture were identified. The medical records of each patient were reviewed to ascertain the mechanism of injury, indication for surgical intervention, and treatment course. Clinical outcomes were evaluated with respect to time to fracture union, postoperative shoulder range of motion, and symptoms related to the fracture site and ipsilateral shoulder. The inpatient postoperative course and outpatient follow-up visits were assessed in an effort to document the incidence of postoperative complications. The most common mechanism of injury was participation in athletic activity. Operative indications included significant deformity, polytrauma, and neurovascular compromise. The mean time from injury to operative fracture stabilization was 15.8 days. No intraoperative complications occurred. All 16 patients (100%) were available for follow-up to fracture union, which occurred in all cases at a mean of 12.4 weeks. Of the 16 patients, 14 were available for further follow-up, and at a mean follow-up of 9 months, 85.7% had regained near-full to full range of shoulder motion and 93% had no symptoms related to the fracture site or ipsilateral shoulder. Postoperative complications occurred in 8 patients (50%), including 3 cases of skin breakdown related to hardware prominence, 2 cases of hardware breakage, 2 cases of decreased sensation in the region of the surgical incision, and 1 case of persistent pain over the operative site. When indicated, the use of intramedullary devices for the stabilization of clavicle fractures offers theoretic advantages over traditional plate and screw fixation. In this case series, intramedullary Hagie pin fixation resulted in fracture union in 100% of cases, with a high percentage of patients regaining full range of shoulder motion and resolution of symptoms. However, there was a 50% incidence of postoperative complications associated with this treatment method. We believe that the complication rate associated with the use of the Hagie pin should preclude the use of this particular implant.     

Operative treatment of clavicle fractures in children]

We studied retrospectively, 23 fractures of the clavicle in children treated by K-wire stabilization between 1999 and 2001. We performed open reduction in 22 children. In one child percutaneous pinning was possible. The anatomical reduction was achieved in all cases. The postoperative course was uneventful in all cases, we didn't notice any infectious complication. The irritation of skin above the protruding end of pin was the only complaint. The pins were removed after 2-4 months. No any additional immobilisation was applied.     

克氏针髓内固定治疗锁骨骨折

锁骨骨折通常保守治疗 ,但对有明显移位的锁骨骨折需手术治疗。若采用钢板螺钉内固定虽固定坚固 ,但手术切口大 ,局部组织损伤较重。我们对锁骨中、外 1/ 3骨折则采用 2ｍｍ克氏针髓内固定 ,斜形骨折再加钢丝环扎 ,疗效满意。1　病例资料1992～ 1996年 ,我院共收治锁骨骨折 146例 ,其中男 12 1例 ,女 2 5例 ,年龄 14～ 46岁。所有骨折均因车祸或跌伤所致。伴明显移位单纯锁骨骨折 10 9例 ,多发性骨折 37例。骨折后1周内手术 96例 ,3周内手术 5 0例。其中 6例为术后骨不连。2　手术方法患者仰卧位 ,患侧肩下垫高 ,以骨折处为中心做一长 3～ …     

Operative and nonoperative treatment of clavicle fractures in adults

Background and purpose

Traditionally, clavicle fractures have been treated nonoperatively. However, many recent studies have concentrated on the results of operative treatment. We assessed and compared the outcomes of operative and nonoperative treatment for acute clavicle fractures in adults.

Methods

We performed a systematic search of the medical literature from 1966 until the end of March 2011. We included randomized controlled trials and controlled clinical trials comparing operative and nonoperative treatment and studies comparing different operative and nonoperative treatments. We required that there should be at least 30 adult patients and a follow-up of at least 6 months in each individual trial. We used the GRADE method to assess the quality of evidence.

Results

6 randomized controlled trials (n = 631) and 7 controlled clinical trials (n = 559) were included. There was moderate-quality evidence (i.e. of grade B) (1) that surgery has considerable effectiveness on better function and less disability at short follow-up, (2) of similar risk of relatively mild complications after operative or nonoperative treatment, (3) that delayed union and nonunion were more common in patients who were treated nonoperatively than in those treated operatively, and (4) that the osteosynthesis method had no effect on the incidence of delayed union or nonunion. Only 1 controlled clinical trial was found on lateral clavicle fractures with very limited (grade D) evidence.

Interpretation

Patients treated operatively have slightly better function and less disability than those treated nonoperatively at short follow-up, but then the effectiveness diminishes and is weak at 6 months. The different operative techniques may not differ in effectiveness or in adverse effects, but the evidence is very limited or conflicting. Surgery could be considered for active patients who require recovery to the previous level of activity in the shortest possible time.Clavicle fractures comprise 2% of all fractures and 35–45% of all shoulder girdle injuries in adults (Nordqvist and Petersson 1994, Postacchini et al. 2002). The incidence in western countries is around 50–64 per 10⁵ (Nordqvist and Petersson 1994, Nowak et al. 2000). They are more common in men (68%) (Postacchini et al. 2002).Clavicle fractures are classified according to the anatomical site and degree of displacement (Neer 1960, Allman 1967, Robinson 1998). Most clavicle fractures are situated in the middle part (81%), whereas lateral (17%) and medial fractures (2%) are much less common (Postacchini et al. 2002).By tradition, midshaft clavicle fractures have been treated nonoperatively with the arm immobilized in a sling for few weeks. The goal is to restore function of the upper extremity and to prevent any constant disability from the injury. Recently, there has been increasing interest in the operative treatment (COTS 2007, Smekal et al. 2009).In this systematic review, based on randomized controlled trials and controlled clinical trials, we assessed the effectiveness and adverse effects of operative and nonoperative treatment of acute clavicle fractures in adults.     

钛弹性髓内钉治疗锁骨干骨折的临床应用

目的 :探讨钛弹性髓内钉(TEN)替代钢板微创治疗锁骨干骨折的疗效。方法 :自2010年2月至2013年2月,采用弹性髓内钉微创治疗62例锁骨干骨折患者,男27例,女35例;年龄15~62岁,平均37.6岁;病程1~9 d,平均2.7 d。39例闭合复位内固定成功,23例需要在骨折端作约3 cm切口辅助复位内固定。根据OTA(Orthopaedic Trauma Association classification)分型,简单骨折有5例06-A1,15例06-A2,11例06-A3,楔形骨折有4例06-B1,12例06-B2,15例06-B3。观察患者术后疼痛缓解情况进行VAS评分,记录手术时间、骨折愈合时间。术后6周及去除内固定后行肩关节Constant评分,术后6周行肩关节Herscovici评分。结果:除2例失访,2例未取内固定,3例骨折尚未愈合患者,其余55例患者获随访,平均随访时间11.4个月。患者术前患肩疼痛VAS评分5.20±0.71,术后第3天VAS评分1.55±0.59,疼痛缓解显著。手术时间15~65 min,平均40 min。骨折愈合时间2~5个月,平均(2.71±0.54)个月;简单骨折与楔形骨折、切开复位和闭合复位患者骨折愈合时间差异均无统计学意义。术后根据Herscovici标准评定患侧肩关节功能:优49例,良4例,可1例,差1例。肩关节Constant评分在术后6周简单骨折患者肩关节功能优于楔形骨折患者;在内固定取出后4周简单骨折和楔形骨折肩关节Constant评分无明星差异。结论:钛弹性髓内钉(ETN)治疗有移位的锁骨干骨折患者临床效果良好,疼痛缓解迅速,术后肩关节功能恢复快。对于OTA分型B型的粉碎骨折患者也能替代钢板取得很好效果,但是要掌握合适的适应证。     

Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting

We reviewed a series of fifty patients who had a non-union of a fracture of the clavicle. Twenty-one patients (42 per cent) who had a symptomatic non-union of the middle of the shaft of the clavicle were treated with open reduction, internal fixation with a modified Hagie intramedullary pin, and autogenous bone-grafting, and those patients form the basis for the report. The average duration of follow-up was thirty-five months (range, five months to eleven years). Healing occurred in twenty (95 per cent) of the twenty-one patients. Intramedullary fixation has several advantages compared with other treatments, such as fixation with a plate and screws. It can be performed through a cosmetically acceptable incision in the Langer line; less dissection of the soft tissues is needed; and, after healing, the pin can be removed through a small incision under local anesthesia.     

锁骨骨折手术治疗412例

我院自 1988年 6月～ 2 0 0 0年 12月对 4 12例锁骨骨折病人行切开复位内固定治疗 ,取得满意的疗效 ,现报道如下。1　临床资料本组 4 12例中男性 2 98例 ,女性 114例 ;年龄 14～ 6 7岁 ,平均 32 5岁。骨折类型 :横形 14 3例 ,斜形 10 3例 ,粉碎性16 6例 ,其中开放性骨折 12例 ,余为闭合性骨折 ,新鲜骨折383例 ,陈旧骨折 2 9例。骨折部位 :中 1/ 3段 30 7例 ,中外 1/3段 92例 ,内 1/ 3段 13例。损伤原因 :车祸伤 2 87例 ,高处坠落伤 5 8例 ,摔伤 4 2例 ,重物压伤 2 2例 ,机器伤 3例。合并伤 :血气胸 11例 ,四肢骨折 132例 ,臂丛神经损伤 2例…     

分叉式交锁髓内钉治疗肱骨干骨折

目的报告肱骨分叉式交锁髓内钉(BLIN型钉)治疗肱骨干骨折的疗效。方法用BLIN型钉治疗肱骨干骨折20例,钢板治疗肱骨干骨折29例,分别从手术情况、并发症、生物力学、骨折愈合情况、功能恢复等方面进行比较。结果随访4～16个月,钢板组平均骨折愈合时间4.2月,术后桡神经麻痹4例,螺钉松动、钢板弯曲1例,骨不连2例。BLIN型钉组平均骨折愈合时间9.6月,术后无一例发生桡神经麻痹,无一例钢钉折弯或断裂,骨折愈合牢固可靠,功能恢复良好。结论肱骨分叉式交锁髓内钉治疗肱骨干骨折,虽然骨折愈合时间较钢板长,但其他方面均优于钢板。     

Operative treatment of displaced lateral malleolar fractures: the Knowles pin technique

OBJECTIVES: To assess the use of Knowles pin fixation for isolated displaced lateral malleolar fractures and to present our surgical experience using this method. DESIGN: Retrospective evaluation. SETTING: The study was carried out at a municipal teaching hospital. The senior surgeons were all orthopedic trauma subspecialists. PATIENTS: A total of 168 patients meeting our inclusion criteria, an isolated displaced lateral malleolar fracture surgically treated by a Knowles pin between 1995 and 2000, were studied. All the patients had a stable syndesmosis, less than 50% comminution, and had no other operations in the same extremity. Patients were assigned into 4 groups according to the Orthopedic Trauma Association classification of ankle fractures. INTERVENTION: Open reduction and internal fixation with a Knowles pin fixation of the lateral malleolus. MAIN OUTCOME MEASUREMENTS: Functional results were evaluated using the Baird and Jackson ankle scoring system. RESULTS: There was a 100% union rate. The average satisfactory outcome of the 4 groups was 88.1%. No instrumentation problems were encountered. Three complications occurred, but resolved with nonoperative therapy. CONCLUSIONS: Knowles pin fixation for displaced lateral malleolar fractures is a useful and effective method. This implant offers several advantages, including easy application, less soft tissue dissection, less palpable instrumentation, stable fixation, and a short operating time.     

Operative treatment of clavicle fractures in children: a review of 21 years

Between 1980 and 2000, 15 children (14 boys and 1 girl) underwent surgical treatment of a fractured clavicle at the authors' hospital. Eight patients were treated for midshaft fracture, two had medial fractures, and five had fractures to the lateral end, one of which occurred in combination with true disruption of the acromioclavicular joint. The indications for operative treatment of clavicle fractures are rare, in some cases debatable, and surgery is usually necessary only in older children. If surgically treated, the results are satisfactory without major complications. In the authors' experience intramedullary stabilization with elastic nails is the method of choice in most cases.     

AO钛制弹性髓内钉在锁骨骨折中的临床应用

大多数的锁骨中段骨折保守治疗可以获得比较满意的效果.但对于移位明显、短缩大于2 cm、伴有浮肩损伤的锁骨中段骨折,保守治疗后骨不连、畸形愈合、肩部疼痛、乏力等并发症的发生率很高,因此目前多主张采用手术治疗.     

Management of displaced midshaft clavicle fractures in adolescent patients using intramedullary flexible nails: A case series

Introduction

Clavicle fractures are common injuries in adolescent patients. In this study we present our technique and results for treating non-comminuted displaced midshaft clavicle?fractures using flexible intra medullary nails.

Operative outcome of displaced medial-end clavicle fractures in adults

The results following nonoperative treatment of displaced, medial end clavicle fractures is often unsatisfactory; but no study has yet reported the outcome of operative fixation of these fractures. This study reports the results of open reduction and internal fixation on displaced, medial end clavicle fractures, in five adult patients (aged 25-52 years, mean 43) including 1 patient with a nonunion. The mean follow-up was 3.3 years (8 months-10.3 years). All fractures had united clinically and radiologically. No complications occurred, and no revision surgery was required. VAS pain scores averaged 0.75 (0-2) at rest, 0.75 (0-2) for normal activities, and 1.0 (0-2) for heavy activities. The mean DASH score was 9.0 (0-17), and all patients were very satisfied with the results of surgery (VAS 10). All patients had a full range of motion of their shoulder at final follow-up and were able to return to pre-injury occupational and activity levels.     

经皮克氏针髓内固定治疗掌指骨骨折

目的评价经皮克氏针髓内固定技术在掌、指骨骨折中的治疗效果。方法对84例121处手部掌骨、近节指骨新鲜骨折,在手提式X光机监视下,采用手法整复经皮克氏针髓内固定术治疗。从患者手的肌力、关节活动范围和影像学检查方面进行评价。结果术后平均随访5个月,X线片显示所有骨折均达到解剖复位或近解剖复位,平均4.2周拔除克氏针,除4例5处(均为近侧指间关节)手指伸直受限外,余均与健侧无明显差别,其患指握力与正常侧无明显差异,未出现针道感染。4处伴有近侧指间关节背侧皮肤软组织损伤,局部带蒂岛状皮瓣修复,其中2例伴有伸肌腱损伤一期修复;1例因局部皮肤及软组织挫伤严重,伤口延迟愈合,经换药后愈合。结论采用闭合复位经皮克氏针髓内固定术,具有价格低廉、损伤小、固定确切、内固定取出方便、患者易接受等优点。