Frima H, Hulsmans M H J, Houwert R M, Ahmed Ali U, Verleisdonk E J M M, Sommer C, van Heijl M
Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Department of Surgery, Diakonessen Hospital, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2018 Feb;44(1):119-124. doi: 10.1007/s00068-017-0784-8. Epub 2017 Mar 17.
Implant-related irritation at the entry site is a known disadvantage of intramedullary nailing for clavicle fractures. The purpose of this study was to compare implant-related irritation rates of intramedullary nailing with or without an end cap for displaced midshaft clavicle fractures.
Two cohorts of patients treated with intramedullary nailing with or without an end cap were matched and compared. Primary outcome was patient-reported implant-related irritation. Secondary outcome parameters were complications.
A total of 34 patients with an end cap were matched with 68 patients without an end cap. There was no difference in implant-related irritation (41 versus 53%, P = 0.26). Significantly more minor revisions were observed in the group without an end cap (15 versus 0%, P = 0.03). For complications requiring major revision surgery, significantly more implant failures were observed in the end cap group (12 versus 2%, P = 0.04). Regardless of their treatment, patients with complex fractures (AO/OTA B2-B3) reported significantly more medial irritation compared to patients with simple fractures (AO/OTA B1)(P = 0.02).
The use of an end cap after intramedullary nailing for displaced midshaft clavicle fractures did not result in lower patient-reported irritation rates. Although less minor revisions were observed, more major revisions were reported in the end cap group. Based on the results of this study, no end caps should be used after intramedullary nailing for displaced midshaft clavicle fractures. However, careful selection of simple fractures might be effective in reducing implant-related problems after intramedullary nailing.
植入物相关的入口部位刺激是髓内钉治疗锁骨骨折的一个已知缺点。本研究的目的是比较有或无端帽的髓内钉治疗移位型锁骨中段骨折时植入物相关刺激的发生率。
对两组分别采用有或无端帽的髓内钉治疗的患者进行匹配和比较。主要结局指标是患者报告的植入物相关刺激。次要结局参数是并发症。
共有34例使用端帽的患者与68例未使用端帽的患者进行匹配。植入物相关刺激方面无差异（41%对53%，P = 0.26）。在无端帽组观察到明显更多的小翻修（15%对0%，P = 0.03）。对于需要进行大翻修手术的并发症，端帽组观察到明显更多的植入物失败（12%对2%，P = 0.04）。无论治疗方式如何，与简单骨折（AO/OTA B1）患者相比，复杂骨折（AO/OTA B2 - B3）患者报告的内侧刺激明显更多（P = 0.02）。
髓内钉治疗移位型锁骨中段骨折后使用端帽并未降低患者报告的刺激发生率。虽然观察到小翻修较少，但端帽组报告的大翻修较多。基于本研究结果，髓内钉治疗移位型锁骨中段骨折后不应使用端帽。然而，仔细选择简单骨折可能有助于减少髓内钉治疗后与植入物相关的问题。
