Elastic stable intramedullary nailing of midclavicular fractures in athletes

BACKGROUND: Intramedullary fixation of midclavicular fractures may be a better option than non-operative treatment for high performance/professional athletes because of the potential reduction in recovery time. OBJECTIVES: To evaluate the effectiveness of intramedullary fixation in high performance athletes and the time required to return to sporting activity. METHODS: Data were taken from a prospective study on intramedullary fixation techniques using the elastic stable Ti nail (TEN, Synthes) for the treatment of displaced midclavicular fractures, initiated in 1996. The patients in 12 cases were classified as high performance/professional athletes. These cases were used to evaluate the technique specifically in this population. Fractures were classified according to the Orthopaedic Trauma Association (OTA) system. Patients were evaluated before and after surgery for shoulder function and subjective pain. After the operation, radiological assessments documented fracture healing, and clinical outcomes scores were obtained. Time required to return to training and competition was documented. RESULTS: All fractures were transverse or oblique. Mean (SD) shoulder abduction increased from 36.3 (8) degrees before surgery to 154.2 (17) degrees afterwards (p<0.001). Mean subjective pain score using a visual analogue scale (0-100) decreased from 71.7 (18) points before surgery to 19.2 (6) points (p<0.001) three days after. There were no complications. Hospital stay averaged 2.9 (1) days. Mean delay to resumption of training was 5.9 (1) days, and to resumption of competition it was 16.8 (5) days. The mean Constant clinical outcomes score one year after hardware removal was 98.3 (2) points. CONCLUSIONS: Intramedullary fixation of displaced midclavicular fracture was successful in terms of clinical outcome and rapid resumption of sporting activities. This treatment should be offered to athletes as an alternative to non-operative treatment.