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Both flexible, locked intramedullary nails and precontoured locked plates were effective for clavicular fractures
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According to recently published results, precontoured locked plates and flexible, locked intramedullary nails were both effective in the management of displaced or shortened clavicular fractures.
Researchers identified 72 patients with acute displaced and/or clavicular shaft fractures. Thirty-seven patients were randomly assigned to be managed with an anatomically contoured locked plate and 35 patients were managed with a Sonoma CRx flexible, locked intramedullary nail (Sonoma Orthopedic Products). Investigators recorded incision length, surgical time and union rate. The DASH and Constant Shoulder scores were used to assess the functional outcomes of the shoulder.
Results showed no differences in patient characteristics, fracture type or displacement between the treatment groups. The surgical time was significantly better in patients treated with a locked plate compared with the flexible, locked intramedullary nail (45 vs. 65 minutes). The incision size was also significantly shorter in patients treated with the locked plate compared with patients treated with the flexible, locked intramedullary nail (37 mm vs. 116 mm). Investigators noted both groups had a 100% union rate. Both treatment groups had similar DASH scores at 1.5, 3 and 6 months. However at 12 months, the nailing group had significantly better DASH scores. The difference only had a moderate effect size, according to researchers.
Patients treated with locked plates had substantially greater individual variation in DASH and Constant Shoulder scores than the nail group. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Michael L. Pearl, MD
This randomized trial comparing pre-contoured plates to a flexible, locked intramedullary nail for the treatment of displaced clavicle fractures reports good outcomes with both techniques in experienced hands. The parameters assessed by the authors (surgical time, incision length, DASH score at 12 months) favored the nailing technique. Complications (one in each group) did not seem to favor one group or another but the length of follow up is unclear from the paper and appears to reflect only the first 12 months postoperatively. As a surgeon with extensive experience treating clavicle fractures with plate fixation, this technique seems appealing for the patient for whom a low-profile cosmetic result is desirable. Otherwise, many questions remain. How effectively can one reduce and control the rotational and other misaligned fracture fragments with this technique? In very comminuted fractures, the plate becomes the shape of the clavicle. Longer follow up is also needed to assess if the intramedullary construct introduces a whole new set of complications in the context of subsequent trauma or if hardware removal is needed for other reasons.
Kaiser Permanente
Los Angeles, California
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