Role of Elastic Intramedullary Nails in the Stabilisation of Displaced Midshaft Clavicular Fractures in Adolescents: A Case Series

The aim of this study is to investigate the post-operative functional outcome following the use of titanium elastic intramedullary nailing for non-comminuted, displaced midshaft clavicle fractures in adolescents with greater than 20 mm shortening. Clavicular fractures are common acute shoulder injuries. In children and adolescents, mid-shaft clavicular fractures are managed non-operatively due to the better healing tendency of the bone. However, adolescents are commonly involved in high-energy sports and are poorly compliant with non-operative measures, which could affect healing. Studies have evaluated the use of operative techniques for adolescent clavicular fractures and reported good outcomes. A series of four adolescent patients (ages 10-18; three males and one female) was reviewed retrospectively at our private tertiary hospital. All patients had post-traumatic displaced mid-shaft clavicular fractures treated using intramedullary nailing. The follow-up period ranged from 5.5 to 12 months. The patients were assessed for clinical and radiological union, as well as shoulder functional outcomes. All four patients demonstrated radiological and clinical union at an average of 10 weeks. The average follow-up was 7.8 months. The average QuickDASH score was 1.24 at an average of 11.5 months post-initial injury. There were no recorded complications intra- or post-operatively, apart from one patient who developed medial nail protrusion, which required medial trimming. All patients had their elastic nails removed at an average of 15 weeks. In our series, elastic stable intramedullary nailing (ESIN) is safe and minimally invasive, with excellent patient satisfaction, cosmetic appearance, and overall outcome. We recommend its application in the surgical management of adolescents presenting with displaced mid-shaft clavicle fractures in clinical practice.