Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures

M. H. J. Hulsmans, M. van Heijl, H. Frima, O. A. J. van der Meijden, H. R. van den Berg, A. H. van der Veen, A. C. Gunning, R. M. Houwert, E. J. M. M. Verleisdonk

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: Implant-related irritation is a technique-specific complication seen in a substantial number of patients treated with intramedullary nailing for clavicle fractures. The purpose of this study was to identify predictors for developing implant-related irritation in patients with displaced midshaft clavicle fractures treated with elastic stable intramedullary nailing. Methods: A retrospective analysis of the surgical database in two level 2 trauma centers was performed. Patients who underwent intramedullary nailing for displaced midshaft clavicle fractures between 2005 and 2012 in the first hospital were included. Age, gender, fracture comminution and fracture location were assessed as possible predictors for developing irritation using multivariate logistic regression analysis. These predictors were externally validated using data of patients treated in another hospital. Results: Eighty-one patients were included in initial analysis. In the multivariate analysis, comminuted fractures in comparison to non-comminuted fractures (72 vs. 38%, p = 0.027) and fracture location (p < 0.001) were significantly associated with the development of implant-related irritation. In particular, lateral diaphyseal fractures caused irritation compared to fractures on the medial side of the cut-off point (88 vs. 26%). External validation of these predictors in 48 additional patients treated in another hospital showed a similar predictive value of the model and a good fit. Conclusion: Comminuted and lateral diaphyseal fractures were found to be statistically significant and independent predictors for developing implant-related irritation. We, therefore, believe that intramedullary nailing might not be suitable for these types of fractures. Future studies are needed to determine whether alternative surgical techniques or implants would be more suitable for these specific types of fractures.
Original languageEnglish
Pages (from-to)581-587
JournalEuropean Journal of Trauma and Emergency Surgery
Volume44
Issue number4
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

Hulsmans, M. H. J., van Heijl, M., Frima, H., van der Meijden, O. A. J., van den Berg, H. R., van der Veen, A. H., ... Verleisdonk, E. J. M. M. (2018). Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures. European Journal of Trauma and Emergency Surgery, 44(4), 581-587. https://doi.org/10.1007/s00068-017-0848-9
Hulsmans, M. H. J. ; van Heijl, M. ; Frima, H. ; van der Meijden, O. A. J. ; van den Berg, H. R. ; van der Veen, A. H. ; Gunning, A. C. ; Houwert, R. M. ; Verleisdonk, E. J. M. M. / Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures. In: European Journal of Trauma and Emergency Surgery. 2018 ; Vol. 44, No. 4. pp. 581-587.
@article{f60f52108f264f2c9481fcd8f584176f,
title = "Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures",
abstract = "Purpose: Implant-related irritation is a technique-specific complication seen in a substantial number of patients treated with intramedullary nailing for clavicle fractures. The purpose of this study was to identify predictors for developing implant-related irritation in patients with displaced midshaft clavicle fractures treated with elastic stable intramedullary nailing. Methods: A retrospective analysis of the surgical database in two level 2 trauma centers was performed. Patients who underwent intramedullary nailing for displaced midshaft clavicle fractures between 2005 and 2012 in the first hospital were included. Age, gender, fracture comminution and fracture location were assessed as possible predictors for developing irritation using multivariate logistic regression analysis. These predictors were externally validated using data of patients treated in another hospital. Results: Eighty-one patients were included in initial analysis. In the multivariate analysis, comminuted fractures in comparison to non-comminuted fractures (72 vs. 38{\%}, p = 0.027) and fracture location (p < 0.001) were significantly associated with the development of implant-related irritation. In particular, lateral diaphyseal fractures caused irritation compared to fractures on the medial side of the cut-off point (88 vs. 26{\%}). External validation of these predictors in 48 additional patients treated in another hospital showed a similar predictive value of the model and a good fit. Conclusion: Comminuted and lateral diaphyseal fractures were found to be statistically significant and independent predictors for developing implant-related irritation. We, therefore, believe that intramedullary nailing might not be suitable for these types of fractures. Future studies are needed to determine whether alternative surgical techniques or implants would be more suitable for these specific types of fractures.",
author = "Hulsmans, {M. H. J.} and {van Heijl}, M. and H. Frima and {van der Meijden}, {O. A. J.} and {van den Berg}, {H. R.} and {van der Veen}, {A. H.} and Gunning, {A. C.} and Houwert, {R. M.} and Verleisdonk, {E. J. M. M.}",
year = "2018",
doi = "10.1007/s00068-017-0848-9",
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Hulsmans, MHJ, van Heijl, M, Frima, H, van der Meijden, OAJ, van den Berg, HR, van der Veen, AH, Gunning, AC, Houwert, RM & Verleisdonk, EJMM 2018, 'Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures' European Journal of Trauma and Emergency Surgery, vol. 44, no. 4, pp. 581-587. https://doi.org/10.1007/s00068-017-0848-9

Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures. / Hulsmans, M. H. J.; van Heijl, M.; Frima, H.; van der Meijden, O. A. J.; van den Berg, H. R.; van der Veen, A. H.; Gunning, A. C.; Houwert, R. M.; Verleisdonk, E. J. M. M.

In: European Journal of Trauma and Emergency Surgery, Vol. 44, No. 4, 2018, p. 581-587.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures

AU - Hulsmans, M. H. J.

AU - van Heijl, M.

AU - Frima, H.

AU - van der Meijden, O. A. J.

AU - van den Berg, H. R.

AU - van der Veen, A. H.

AU - Gunning, A. C.

AU - Houwert, R. M.

AU - Verleisdonk, E. J. M. M.

PY - 2018

Y1 - 2018

N2 - Purpose: Implant-related irritation is a technique-specific complication seen in a substantial number of patients treated with intramedullary nailing for clavicle fractures. The purpose of this study was to identify predictors for developing implant-related irritation in patients with displaced midshaft clavicle fractures treated with elastic stable intramedullary nailing. Methods: A retrospective analysis of the surgical database in two level 2 trauma centers was performed. Patients who underwent intramedullary nailing for displaced midshaft clavicle fractures between 2005 and 2012 in the first hospital were included. Age, gender, fracture comminution and fracture location were assessed as possible predictors for developing irritation using multivariate logistic regression analysis. These predictors were externally validated using data of patients treated in another hospital. Results: Eighty-one patients were included in initial analysis. In the multivariate analysis, comminuted fractures in comparison to non-comminuted fractures (72 vs. 38%, p = 0.027) and fracture location (p < 0.001) were significantly associated with the development of implant-related irritation. In particular, lateral diaphyseal fractures caused irritation compared to fractures on the medial side of the cut-off point (88 vs. 26%). External validation of these predictors in 48 additional patients treated in another hospital showed a similar predictive value of the model and a good fit. Conclusion: Comminuted and lateral diaphyseal fractures were found to be statistically significant and independent predictors for developing implant-related irritation. We, therefore, believe that intramedullary nailing might not be suitable for these types of fractures. Future studies are needed to determine whether alternative surgical techniques or implants would be more suitable for these specific types of fractures.

AB - Purpose: Implant-related irritation is a technique-specific complication seen in a substantial number of patients treated with intramedullary nailing for clavicle fractures. The purpose of this study was to identify predictors for developing implant-related irritation in patients with displaced midshaft clavicle fractures treated with elastic stable intramedullary nailing. Methods: A retrospective analysis of the surgical database in two level 2 trauma centers was performed. Patients who underwent intramedullary nailing for displaced midshaft clavicle fractures between 2005 and 2012 in the first hospital were included. Age, gender, fracture comminution and fracture location were assessed as possible predictors for developing irritation using multivariate logistic regression analysis. These predictors were externally validated using data of patients treated in another hospital. Results: Eighty-one patients were included in initial analysis. In the multivariate analysis, comminuted fractures in comparison to non-comminuted fractures (72 vs. 38%, p = 0.027) and fracture location (p < 0.001) were significantly associated with the development of implant-related irritation. In particular, lateral diaphyseal fractures caused irritation compared to fractures on the medial side of the cut-off point (88 vs. 26%). External validation of these predictors in 48 additional patients treated in another hospital showed a similar predictive value of the model and a good fit. Conclusion: Comminuted and lateral diaphyseal fractures were found to be statistically significant and independent predictors for developing implant-related irritation. We, therefore, believe that intramedullary nailing might not be suitable for these types of fractures. Future studies are needed to determine whether alternative surgical techniques or implants would be more suitable for these specific types of fractures.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/28993839

U2 - 10.1007/s00068-017-0848-9

DO - 10.1007/s00068-017-0848-9

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JO - European Journal of Trauma and Emergency Surgery

JF - European Journal of Trauma and Emergency Surgery

SN - 1863-9933

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