Elastic stable intramedullary nailing (ESIN) for displaced midshaft clavicle fractures in adolescents (12-18 Years): a study of early functional outcomes and safety.

BACKGROUND

Displaced midshaft clavicle fractures in adolescents aged 12 to 18 present challenges for conservative management because of muscle-induced redisplacement and decreased skeletal plasticity. Elastic stable intramedullary nailing (ESIN) provides a minimally invasive alternative; however, the evidence supporting its use in this age group remains limited.

METHODS

Twenty-three adolescents (14 boys and 9 girls, with a mean age of 14.8 years) underwent closed reduction and percutaneous elastic stable intramedullary nailing (CR-PEIN) for the treatment of displaced midshaft clavicle fractures. The outcomes assessed included the union rate, incidence of complications, and functional scores.

RESULTS

CR-PEIN achieved a 100% union rate with a mean time to union of 10.0 weeks. The mean operative time was 31.6 min, mean blood loss was 2.5 mL, and the mean fluoroscopy count was 4.5 times. Complications included nail irritation in 8.7% of cases (2/23), which resolved post-removal. All patients achieved a Disabilities of the Arm, Shoulder and Hand (DASH) score of 0, indicating excellent function, at a mean follow-up of 4.7 months. No re-displacement, re-fracture, or hardware failure was observed during the follow-up period.

CONCLUSIONS

CR-PEIN represents a safe and effective treatment option for displaced midshaft clavicle fractures in adolescents. It offers advantages such as short operative times, brief hospital stays, minimal scarring concerns, rapid functional recovery, and ease of implant removal. This minimally invasive technique serves as a valuable therapeutic reference for managing displaced midshaft clavicle fractures in children within this age group.