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Evaluation of minimally invasive fixation with ESIN in the management of displaced mid-shaft clavicle fractures: a case series with minimum of 2 years follow-up

Background: Over the last few years, operative treatment has become the standard for treatment of clavicle fractures. Both plating and intra-medullary pinning techniques are available for treating clavicle fractures. The aim of the study was to evaluate the role of minimally invasive technique using elastic stable intramedullary nailing (ESIN) in surgical treatment of displaced mid-shaft clavicle fractures . Methods: It is a prospective case series study conducted at the Department of Orthopaedics of a tertiary care centre. 44 cases of acute displaced mid-shaft clavicle fractures with a mean age of 32.7 years were treated by intramedullary pinning with titanium elastic stable nails and were followed-up for a mean period of 30.6 months(range= 24-40 months). Functional outcomes were evaluated by using Constant Shoulder score. The results obtained were analysed using student’s t-test. Results: Union was achieved in all except one case which showed delayed union. 7 cases were complicated by telescoping (incidence= 15.9%) and 6 out of these 7 cases also had medial nail protrusion (incidence= 13.6%) simultaneously. 9 cases had shortening of less than 1cm and 2 had shortening of more than 1cm.  No other complication was reported from any of the case. Mean constant shoulder scores improved from 15 to 85.6 (p value <0.001) after 12 months from surgery. However, no further improvement was seen after 12 months of surgery, with no statistical difference (p value= 0.789) between the mean scores at 12 (85.6) and 24 (85.7) months . Conclusions: ESIN offers the advantages of treating displaced mid-shaft clavicle fractures with minimal incision and decreased surgery time with minimal intra-operative blood loss. The results were excellent in terms of functional outcomes. The complication rates were low and return to normal activity was quiet fast. ESIN is a minimally invasive technique with good cosmetic and functional results. This method should be seen as an alternative to plate fixation and non-operative treatment .