Analysis of clinical efficacy of retrograde elastic intramedullary nailing fixation in the treatment of displaced midshaft clavicle fractures in adolescents

JI Zhong-yu; YU Hong; YIN Tong-zhen; YANG Jin-chang; ZHOU Long-long; LI Mei

doi:10.3969/j.issn.2095-252X.2026.03.001

Abstract：Objective To investigate the clinical efficacy of minimally invasive treatment for displaced midshaft clavicle fractures in adolescents using retrograde elastic intramedullary nailing fixation.Methods A retrospective analysis was performed on 38 adolescents with displaced midshaft clavicle fractures(overlapping or separated)treated with minimally invasive retrograde elastic intramedullary nailing between January 2023 and April 2024.The cohort included 24 males and 14 females,with 21 left and 17 right clavicle fractures.Causes of injury were:traffic accidents(5 cases),bicycle falls(12 cases)and sports-related falls(21 cases).Radiographs showed transverse fractures in 20 cases,short oblique fractures in 10 and comminuted fractures in 8.The affected and healthy sides were assessed using the Constant-Murley shoulder score at 4 weeks,8 weeks,12 weeks,6 months and 12 months postoperatively.The overall score from the Patient and Observer Scar Assessment Scale was recorded.Radiographs were reviewed to evaluate fracture union,loss of reduction and implant stability.Results All 38 cases were treated minimally invasively using retrograde elastic intramedullary nailing fixation.The follow-up period ranged from 12 to 18 months with a fracture healing time of(6±2)weeks.The Constant-Murley shoulder function scores at 4,8 and 12 weeks were(54.90±4.32),(83.25±16.73)and(97.76±2.13)respectively.Compared with the pre-treatment score of(22.48±4.18),the differences were statistically significant(F=1321.352,P<0.001).At 8 weeks,the Constant-Murley score of the affected side was comparable to that of the contralateral healthy side(P>0.05).The overall Patient and Observer Scar Assessment Scale score was 2.5 and all patients were satisfied with the shoulder appearance.All fractures achieved union.The elastic intramedullary nails were removed 6 to 10 months postoperatively.No complications such as infection,implant failure or re-fracture occurred.Postoperatively,two patients experienced implant irritation at the nail tip and two patients underwent minimal incision with Kirschner wire-assisted reaming prior to fixation due to a narrow intramedullary canal of the clavicle.Conclusions The retrograde elastic intramedullary nailing technique for minimally invasive treatment of displaced midshaft clavicle fractures in adolescents offers advantages including minimal surgical trauma,rapid functional recovery,concealed incisions and few complications.It provides a new surgical option for the minimally invasive management of these fractures in adolescents.