Medical College, Soochow University, Suzhou, Jiangsu, China.
Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
BMC Musculoskelet Disord. 2024 Jan 13;25(1):59. doi: 10.1186/s12891-024-07197-4.
The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures.
A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded.
The length of the incision was 2-6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92-100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12-26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm).
Intramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures.
Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People's Hospital (LW20220021).
完全移位的锁骨中段骨折的治疗仍存在争议，尤其是 Robinson 2B 型骨折。钛弹性钉（TEN）固定是治疗简单骨折的一种较好选择，但尚无关于其在复杂骨折中应用的报道。本研究旨在介绍一种使用 Nice 结辅助 TEN 固定治疗 Robinson 2B 型锁骨中段骨折的手术方法。
回顾性分析了 2016 年至 2020 年期间采用 TEN 固定且术后随访 1 年的 29 例患者。骨折分为 17 例 Robinson 2B1 型和 12 例 Robinson 2B2 型。记录切口长度、术后肩关节功能障碍臂肩手（DASH）评分和Constant 评分、并发症发生率和二次手术切口长度。
切口长度为 2-6cm（平均 3.7cm）。所有切口均一期愈合，无感染或神经损伤发生。Constant 评分为 92-100（平均 96），DASH 评分为 0-6.2（平均 2.64）。1 例（3.4%）发生 TEN 弯曲和肥大性骨不连，4 例（13.8%）发生植入物刺激。术后 12-26 个月（平均 14.6 个月）取出内固定植入物，二次手术切口长度为 1-2.5cm（平均 1.3cm）。
TEN 髓内固定被认为是锁骨骨折治疗的一种合适的手术技术。Nice 结辅助固定为多段骨折提供稳定，有助于骨折愈合。外科医生应考虑在治疗 Robinson 2B 型锁骨中段骨折时采用这种技术。
回顾性注册。本研究得到了无锡市第九人民医院伦理委员会的批准（LW20220021）。
