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. 2025 May 24;20(1):507.
doi: 10.1186/s13018-025-05923-9.

Elastic stable intramedullary nailing (ESIN) for displaced midshaft clavicle fractures in adolescents (12-18 Years): a study of early functional outcomes and safety

Wenbing Zhang  1 , Jun Chen  2
Affiliations

Elastic stable intramedullary nailing (ESIN) for displaced midshaft clavicle fractures in adolescents (12-18 Years): a study of early functional outcomes and safety

Wenbing Zhang et al. J Orthop Surg Res. .

Abstract

Background: Displaced midshaft clavicle fractures in adolescents aged 12 to 18 present challenges for conservative management because of muscle-induced redisplacement and decreased skeletal plasticity. Elastic stable intramedullary nailing (ESIN) provides a minimally invasive alternative; however, the evidence supporting its use in this age group remains limited.

Methods: Twenty-three adolescents (14 boys and 9 girls, with a mean age of 14.8 years) underwent closed reduction and percutaneous elastic stable intramedullary nailing (CR-PEIN) for the treatment of displaced midshaft clavicle fractures. The outcomes assessed included the union rate, incidence of complications, and functional scores.

Results: CR-PEIN achieved a 100% union rate with a mean time to union of 10.0 weeks. The mean operative time was 31.6 min, mean blood loss was 2.5 mL, and the mean fluoroscopy count was 4.5 times. Complications included nail irritation in 8.7% of cases (2/23), which resolved post-removal. All patients achieved a Disabilities of the Arm, Shoulder and Hand (DASH) score of 0, indicating excellent function, at a mean follow-up of 4.7 months. No re-displacement, re-fracture, or hardware failure was observed during the follow-up period.

Conclusions: CR-PEIN represents a safe and effective treatment option for displaced midshaft clavicle fractures in adolescents. It offers advantages such as short operative times, brief hospital stays, minimal scarring concerns, rapid functional recovery, and ease of implant removal. This minimally invasive technique serves as a valuable therapeutic reference for managing displaced midshaft clavicle fractures in children within this age group.

Keywords: Adolescent; Clavicle fractures; Elastic stable intramedullary nailing; Minimally invasive.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by Ethics Committee of The People’s Hospital of Bishan District of Chongqing (cqbykyll-20240816-02). At the direction of Ethical Committee of Research, informed consent was not required for retrospective study, and it was clarified that the subjects could opt out of the study at any time. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Typical case: (a) A displaced midshaft clavicle fracture of right in a 15.6 years old boy; (b) The first postoperative day; (c) The first postoperative week; (d) The first postoperative month; (e) The second postoperative month; (f)The third postoperative month.The right clavicle fracture healed and the ESIN had been removed
See this image and copyright information in PMC

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