Georgian medical news · 2025
OSTEOSYNTHESIS OF CLAVICLE FRACTURES IN CHILDREN USING TITANIUM ELASTIC NAILS.
СтатьяНазвание и аннотация: Перевод в очереди
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Chitaia L, Saganelidze Kh, Vardiashvili R
Аннотация
OBJECTIVES: Titanium Elastic Nail (TEN) fixation provides superior clinical and cosmetic outcomes with fewer complications compared to plating or Kirschner wire fixation in pediatric clavicle fractures.
BACKGROUND: Clavicle fractures account for about 10% of all paediatric fractures. In displaced or unstable cases, surgical fixation is increasingly advocated. Titanium elastic nails (TEN) offer a minimally invasive intramedullary fixation option, but outcomes in children remain less widely documented.
DESIGN: Retrospective cohort design study.
SETTING: Single tertiary care center.
PATIENT SELECTION: Patients aged 10-18 years with acute clavicle fractures treated surgically between January 2021 and December 2024 were included. Patients were selected according to OTA/AO classification. Surgical technique selection was based on fracture characteristics: midshaft fractures with moderate displacement (15A-B types) were primarily treated with TEN fixation (n=48); severely comminuted or segmental fractures requiring anatomical plate fixation (n=11, 15C type); and simple transverse fractures amenable to K-wire fixation (n=13, 15A type). The observed difference in group sizes reflects the clinical distribution of fracture patterns and the preferential use of TEN for appropriate cases during the study period. Exclusion criteria included pathologic fractures, open fractures requiring complex reconstruction, and noncompliance with follow-up.
OUTCOMES: Primary outcome - radiographic union. Secondary outcomes - complications, functional outcomes, cosmetic satisfaction. Comparisons made between TEN, plating, and K-wire groups.
DATA COLLECTION: Extracted from electronic medical and radiographic records by two independent reviewers.
METHODS: This is a retrospective review of 72 pediatric patients (age 10-18) with clavicle fractures treated surgically at our center from 2021 to 2024. Fixation techniques included closed reduction with TEN (n=48), open reduction with plating (n=11), and intramedullary Kirschner wires (n=13). We evaluated radiographic union, complications, functional outcomes, and cosmetic satisfaction.
RESULTS: Demographics and Baseline Data: Seventy-two patients (58 males, 14 females; mean age 14±4 years) were included. Mean follow-up was 12 months. Radiographic Union and Healing: Union achieved in 47/48 TEN, 9/11 plating, 12/13 K-wire cases. Mean union time 4±1 weeks for TEN group. No statistically significant difference in union time across groups.
COMPLICATIONS: TEN: skin irritation (n=1). Plating: non-union (n=1), plate deformation (n=1), refracture (n=1). K-wire: migration (n=3). No infections noted. Functional Outcomes: All patients achieved near-normal shoulder motion. Return to sport earliest in TEN group (~4 weeks). Cosmetic Satisfaction: TEN: minimal scarring (~1.5 cm incision) and excellent satisfaction. Plating and K-wire: visible scars and hardware prominence complaints. Comparisons Between Groups: Equivalent union rates observed, but TEN group had fewer complications and superior aesthetics.
CONCLUSIONS: • Titanium Elastic Nails (TEN) provide effective, minimally invasive fixation for pediatric clavicle fractures. • Faster recovery and better cosmetic outcomes than plating or K-wires. • Low complication rate and high union success make TEN a preferred option in eligible pediatric cases.
LEVEL OF EVIDENCE: III.
BACKGROUND: Clavicle fractures account for about 10% of all paediatric fractures. In displaced or unstable cases, surgical fixation is increasingly advocated. Titanium elastic nails (TEN) offer a minimally invasive intramedullary fixation option, but outcomes in children remain less widely documented.
DESIGN: Retrospective cohort design study.
SETTING: Single tertiary care center.
PATIENT SELECTION: Patients aged 10-18 years with acute clavicle fractures treated surgically between January 2021 and December 2024 were included. Patients were selected according to OTA/AO classification. Surgical technique selection was based on fracture characteristics: midshaft fractures with moderate displacement (15A-B types) were primarily treated with TEN fixation (n=48); severely comminuted or segmental fractures requiring anatomical plate fixation (n=11, 15C type); and simple transverse fractures amenable to K-wire fixation (n=13, 15A type). The observed difference in group sizes reflects the clinical distribution of fracture patterns and the preferential use of TEN for appropriate cases during the study period. Exclusion criteria included pathologic fractures, open fractures requiring complex reconstruction, and noncompliance with follow-up.
OUTCOMES: Primary outcome - radiographic union. Secondary outcomes - complications, functional outcomes, cosmetic satisfaction. Comparisons made between TEN, plating, and K-wire groups.
DATA COLLECTION: Extracted from electronic medical and radiographic records by two independent reviewers.
METHODS: This is a retrospective review of 72 pediatric patients (age 10-18) with clavicle fractures treated surgically at our center from 2021 to 2024. Fixation techniques included closed reduction with TEN (n=48), open reduction with plating (n=11), and intramedullary Kirschner wires (n=13). We evaluated radiographic union, complications, functional outcomes, and cosmetic satisfaction.
RESULTS: Demographics and Baseline Data: Seventy-two patients (58 males, 14 females; mean age 14±4 years) were included. Mean follow-up was 12 months. Radiographic Union and Healing: Union achieved in 47/48 TEN, 9/11 plating, 12/13 K-wire cases. Mean union time 4±1 weeks for TEN group. No statistically significant difference in union time across groups.
COMPLICATIONS: TEN: skin irritation (n=1). Plating: non-union (n=1), plate deformation (n=1), refracture (n=1). K-wire: migration (n=3). No infections noted. Functional Outcomes: All patients achieved near-normal shoulder motion. Return to sport earliest in TEN group (~4 weeks). Cosmetic Satisfaction: TEN: minimal scarring (~1.5 cm incision) and excellent satisfaction. Plating and K-wire: visible scars and hardware prominence complaints. Comparisons Between Groups: Equivalent union rates observed, but TEN group had fewer complications and superior aesthetics.
CONCLUSIONS: • Titanium Elastic Nails (TEN) provide effective, minimally invasive fixation for pediatric clavicle fractures. • Faster recovery and better cosmetic outcomes than plating or K-wires. • Low complication rate and high union success make TEN a preferred option in eligible pediatric cases.
LEVEL OF EVIDENCE: III.