title: [Intramedullary Stabilisation of Displaced Midshaft Clavicular Fractures in Heavy Workers and Complex Fracture Pattern].
abstract: BACKGROUND
  The medical literature recommends plate osteosynthesis (PO) for complex displaced midshaft clavicular fractures (DMCF) OTA type 15B3 and for heavy workers with displaced clavicular fractures. Recovery of DMCF treated with intramedullary stabilisation (IMS) will be examined and compared to published data for duration of inability to work (DIW) after conservative treatment as well as after PO, with respect to the DIW.
  
  
  METHODS
  Between 09/2009 and 07/2015, the DIW of 58 patients (8 f, 50 m, mean age 38.4 [20-59] years) with DMCF treated with open reduction and IMS (Titanium Elastic Nail [TEN], Synthes, Umkirch, Germany) was determined. Inclusion criteria were the presence of closed unilateral DMCF and presence of a job with national insurance at the time of accident. DIW was counted in days, starting with the accident, and ending on the last day before resumption of full work. All patients were functionally treated for 6 weeks postoperatively without weights for the shoulder and with a maximum of 90° abduction/flexion. The workload was classified in accordance with REFA criteria: group 0-1 (low physical workload) and group 2-4 (high physical workload). Fracture patterns (simple vs. complex) and postoperative physiotherapy (yes vs. no) were investigated for both REFA groups, as these factors may influence DIW. Fracture classification was performed in accordance with the OTA classification, as simple fractures (OTA type 15B1 and 15B2), and complex fractures (OTA type 15B3). Effects were concerned significant if p ≤ 0.05.
  
  
  RESULTS
  Median DIW was independent of physical workload, with 39.86 (3-150) days (n = 58). Patients with low physical workload (REFA 0-1; n = 33) had shorter duration of DIW, with an average of 32.48 (3-136) days than patients with higher physical workload (REFA 2-4; n = 25), with 49.6 (14-150) days (p = 0.02). The fracture type did not influence this significantly (simple fractures [n = 35]: average 40.54 [3-150] days; complex fractures [n = 23]: average 38.82 [14-136] days, p = 0.85). Within each REFA group, differences in DIW for each fracture type were greater, but did not attain statistical significance. Patients without postoperative PT (n = 30) had a shorter DIW, with an average of 30.5 (3-84) days, than patients with postoperative PT (n = 28), with an average of 49.89 (14-150) days (p = 0.021). Within both REFA groups, DIW changed similarly with postoperative PT, in some cases with statistical significance.
  
  
  CONCLUSIONS
  DIW after IMS of DMCF does not depend on the complexity of the fracture. For heavy workers, DIW after IMS is significantly longer than for light physical workers. IMS of DMCF permits immediate pain-adapted movement of the shoulder, with a maximal abduction/flexion up to 90°, no matter what the fracture type. Patients given additional professional PT showed longer DIW than those without such treatment.
authors.affiliation: Klinik für Orthopädie, Unfall- und Handchirurgie, Hegau-Bodensee-Klinikum Singen, Gesundheitsverband Landkreis Konstanz.
authors.forename: R
authors.initials: R
authors.lastname: Langenhan
authors.affiliation: Klinik für Orthopädie, Unfall- und Handchirurgie, Hegau-Bodensee-Klinikum Singen, Gesundheitsverband Landkreis Konstanz.
authors.forename: A
authors.initials: A
authors.lastname: Hecht
authors.affiliation: Klinik für Orthopädie, Unfall- und Handchirurgie, Hegau-Bodensee-Klinikum Singen, Gesundheitsverband Landkreis Konstanz.
authors.forename: S
authors.initials: S
authors.lastname: Bushuven
authors.affiliation: Klinik für Orthopädie, Unfall- und Handchirurgie, Hegau-Bodensee-Klinikum Singen, Gesundheitsverband Landkreis Konstanz.
authors.forename: N
authors.initials: N
authors.lastname: Reimers
authors.affiliation: Klinik für Orthopädie, Unfall- und Handchirurgie, Hegau-Bodensee-Klinikum Singen, Gesundheitsverband Landkreis Konstanz.
authors.forename: A
authors.initials: A
authors.lastname: Probst
mesh_terms: D000328:Adult; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D055815:Young Adult