Clinical comparative study of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation for mid-clavicular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FANG Kaibin ¹ , XU Shuangta ² , ZHENG Yuhui ¹ , HUANG Long ¹ , CHEN Shoubo ¹ , WU Shiqiang ¹ ,  WANG Wenhuai ¹

1. Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;
2. Department of Tumor Surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;

Corresponding author：

WANG Wenhuai, Email: xiaodi50a@163.com

Keywords：

Mid-clavicular fracture; thoracoscopy; intramedullary nail; internal fixation

DOI：

10.7507/1002-1892.201808141

Video：

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Objective To compare the effectiveness of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation in the treatment of mid-clavicular fractures.Methods A prospective randomized controlled trial was conducted. Twenty-two patients with mid-clavicular fractures who met the selection criteria between March 2012 and March 2017 were recruited and randomly divided into trial group (7 cases, thoracoscopic assisted reduction and percutaneous intramedullary nail fixation) and control group (15 cases, traditional manual reduction and percutaneous intramedullary nail fixation). There was no significant difference in gender, age, side, cause of injury, fracture classification, interval between injury and operation between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. The effectiveness was evaluated by Constant-Murley scale at 6 months after operation, which included subjective evaluation indexes (functional activity and pain) and objective evaluation indexes (range of motion of shoulder joint and muscle strength).Results The operation time of the trial group was significantly longer than that of the control group (t=5.881, P=0.000). Patients in both groups were followed up 7-20 months, with an average of 11 months. Satisfactory anatomical reduction achieved in all patients, and all incisions healed by first intension. In the control group, 1 patient had difficulty in removing the intramedullary nail, and 1 patient had fracture nonunion. No fracture nonunion or intramedullary nail rupture in the other patients of two groups. There was no significant difference in fracture healing time between the two groups (t=0.764, P=0.453). At 6 months after operation, there was no significant difference in Constant-Murley scale between the two groups (P>0.05).Conclusion The treatment of the mid-clavicular fracture by using thoracoscopic assisted reduction with intramedullary nail internal fixation requires longer operation time, but does not require fluoroscopy. The effectiveness is comparable to that of traditional surgery.

Citation： FANG Kaibin, XU Shuangta, ZHENG Yuhui, HUANG Long, CHEN Shoubo, WU Shiqiang, WANG Wenhuai. Clinical comparative study of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation for mid-clavicular fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 323-327. doi: 10.7507/1002-1892.201808141 Copy

1.	Naveen BM, Joshi GR, Harikrishnan B. Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strategies Trauma Limb Reconstr, 2017, 12(1): 11-18.
2.	Malik A, Jazini E, Song X, et al. Positional change in displacement of midshaft clavicle fractures: an aid to initial evaluation. J Orthop Trauma, 2017, 31(1): e9-e12.
3.	Onizuka N, Anderson JP, Gilbertson JA, et al. Displacement of diaphyseal clavicle fractures related to patient position and progressive displacement in the peri-injury period. J Shoulder Elbow Surg, 2018, 27(4): 667-673.
4.	Koh YW, Park JH, Kim JW, et al. Clipless and sutureless endoscopic thyroidectomy using only the harmonic scalpel. Surg Endosc, 2010, 24(5): 1117-1125.
5.	Jiang W, Wang H, Li YS, et al. Meta-analysis of differences in Constant-Murley scores for three mid-shaft clavicular fracture treatments. Oncotarget, 2017, 8(47): 83251-83260.
6.	Martetschläger F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elbow Surg, 2013, 22(6): 862-868.
7.	Ranalletta M, Bertona A, Rios JM, et al. Corrective osteotomy for malunion of proximal humerus using a custom-made surgical guide based on three-dimensional computer planning: case report. J Shoulder Elbow Surg, 2017, 26(11): e357-e363.
8.	汤红伟, 殷勇, 韩擎天, 等. 解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的疗效研究. 中国修复重建外科杂志, 2018, 32(9): 1181-1186.
9.	朱立帆, 曾金才, 蒋富贵, 等. 解剖锁定板联合聚酯缝线固定治疗 NeerⅡB 型锁骨远端骨折. 中国修复重建外科杂志, 2017, 31(6): 760-761.
10.	Bravman JT, Vidal AF. Midshaft clavicle fractures: are surgical indications changing? Orthopedics, 2009, 32(12): 909-913.
11.	Waldmann S, Benninger E, Meier C. Nonoperative treatment of midshaft clavicle fractures in adults. Open Orthop J, 2018, 12: 1-6.
12.	Pieracci FM, Agarwal S, Doben A, et al. Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society. Int Orthop, 2018, 42(2): 401-408.
13.	Houwert RM, Smeeing DP, Ahmed Ali U, et al. Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Shoulder Elbow Surg, 2016, 25(7): 1195-1203.
14.	王小林, 邵景范, 杨小进, 等. 弹性髓内针固定治疗大龄儿童严重移位肱骨近端骨折. 中国修复重建外科杂志, 2014, 28(3): 345-348.
15.	Duan X, Zhong G, Cen S, et al. Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg, 2011, 20(6): 1008-1015.
16.	Zhang D, Fu Q, Dionigi G, et al. Intraoperative neural monitoring in endoscopic thyroidectomy via bilateral areola approach. Surg Laparosc Endosc Percutan Tech, 2018, 28(5): 303-308.
17.	Eisenstein ED, Misenhimer JJ, Kotb A, et al. Management of displaced midshaft clavicle fractures in adolescent patients using intramedullary flexible nails: A case series. J Clin Orthop Trauma, 2018, 9(Suppl 1): S97-S102.
18.	Tarazi N, Munigangaiah S, Jadaan M, et al. Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus misonix bonescalpel in spinal surgery. J Craniovertebr Junction Spine, 2018, 9(1): 68-72.
19.	Neunhoeffer F, Warmann SW, Hofbeck M, et al. Elevated intrathoracic CO₂ pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants—A pilot study. Paediatr Anaesth, 2017, 27(7): 752-759.

1. Naveen BM, Joshi GR, Harikrishnan B. Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strategies Trauma Limb Reconstr, 2017, 12(1): 11-18.
2. Malik A, Jazini E, Song X, et al. Positional change in displacement of midshaft clavicle fractures: an aid to initial evaluation. J Orthop Trauma, 2017, 31(1): e9-e12.
3. Onizuka N, Anderson JP, Gilbertson JA, et al. Displacement of diaphyseal clavicle fractures related to patient position and progressive displacement in the peri-injury period. J Shoulder Elbow Surg, 2018, 27(4): 667-673.
4. Koh YW, Park JH, Kim JW, et al. Clipless and sutureless endoscopic thyroidectomy using only the harmonic scalpel. Surg Endosc, 2010, 24(5): 1117-1125.
5. Jiang W, Wang H, Li YS, et al. Meta-analysis of differences in Constant-Murley scores for three mid-shaft clavicular fracture treatments. Oncotarget, 2017, 8(47): 83251-83260.
6. Martetschläger F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elbow Surg, 2013, 22(6): 862-868.
7. Ranalletta M, Bertona A, Rios JM, et al. Corrective osteotomy for malunion of proximal humerus using a custom-made surgical guide based on three-dimensional computer planning: case report. J Shoulder Elbow Surg, 2017, 26(11): e357-e363.
8. 汤红伟, 殷勇, 韩擎天, 等. 解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的疗效研究. 中国修复重建外科杂志, 2018, 32(9): 1181-1186.
9. 朱立帆, 曾金才, 蒋富贵, 等. 解剖锁定板联合聚酯缝线固定治疗 NeerⅡB 型锁骨远端骨折. 中国修复重建外科杂志, 2017, 31(6): 760-761.
10. Bravman JT, Vidal AF. Midshaft clavicle fractures: are surgical indications changing? Orthopedics, 2009, 32(12): 909-913.
11. Waldmann S, Benninger E, Meier C. Nonoperative treatment of midshaft clavicle fractures in adults. Open Orthop J, 2018, 12: 1-6.
12. Pieracci FM, Agarwal S, Doben A, et al. Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society. Int Orthop, 2018, 42(2): 401-408.
13. Houwert RM, Smeeing DP, Ahmed Ali U, et al. Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Shoulder Elbow Surg, 2016, 25(7): 1195-1203.
14. 王小林, 邵景范, 杨小进, 等. 弹性髓内针固定治疗大龄儿童严重移位肱骨近端骨折. 中国修复重建外科杂志, 2014, 28(3): 345-348.
15. Duan X, Zhong G, Cen S, et al. Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg, 2011, 20(6): 1008-1015.
16. Zhang D, Fu Q, Dionigi G, et al. Intraoperative neural monitoring in endoscopic thyroidectomy via bilateral areola approach. Surg Laparosc Endosc Percutan Tech, 2018, 28(5): 303-308.
17. Eisenstein ED, Misenhimer JJ, Kotb A, et al. Management of displaced midshaft clavicle fractures in adolescent patients using intramedullary flexible nails: A case series. J Clin Orthop Trauma, 2018, 9(Suppl 1): S97-S102.
18. Tarazi N, Munigangaiah S, Jadaan M, et al. Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus misonix bonescalpel in spinal surgery. J Craniovertebr Junction Spine, 2018, 9(1): 68-72.
19. Neunhoeffer F, Warmann SW, Hofbeck M, et al. Elevated intrathoracic CO₂ pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants—A pilot study. Paediatr Anaesth, 2017, 27(7): 752-759.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical comparative study of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation for mid-clavicular fractures

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