Abstract
Background:
Displaced midshaft clavicle fractures unite well in children less than 12 years old, owing to their inherent ability to remodel bone. In adolescents, remodeling occurs less and deformity or shortening can result. Recent literature in adults shows improved outcomes of these fractures with operative treatment. It has been suggested that these results may translate to adolescents.
Study Objective:
To assess the effectiveness of titanium elastic TEN nails in the treatment of displaced midshaft clavicle fractures in adolescents.
Methods:
Adolescent patients (age 12 to 18) with closed displaced midshaft clavicle fractures, sustained between 2008 and 2014, were treated operatively by a single surgeon, who inserted a TEN nail in an unreamed fashion from the sternal end of the clavicle. Post-operatively, patients were immobilised in a sling for 6 weeks. The nail was removed routinely at 12 weeks. All patients were assessed by the surgeon at 24 weeks with regards to the radiological outcome, Constant shoulder score, scar quality and complications.
Results:
Thirteen patients, 9 males and 4 females (mean age 14,2 years) were assessed.
Eleven patients had complete union by 6 weeks and the remaining two by 12 weeks.
The Constant score was graded below 11 for all patients by 12 weeks follow up and all patients were satisfied with their scars after 24 weeks.
Two patients developed complications: in one, the nail perforated the posterior cortex of the lateral fragment and the other developed a haematoma.
Conclusion:
Operative treatment with a TEN nail is a safe, minimally invasive and reliable treatment method for displaced midshaft clavicle fractures in adolescents resulting in a satisfactory surgical outcome.
