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. VerleisdonkEmail author
Original Article



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.


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.


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.


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.


TEN Intramedullary Clavicle fracture Fixation Complication 


Compliance with ethical standards

Conflict of interest

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 and E.J.M.M. Verleisdonk declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • M. H. J. Hulsmans
    • 1
  • M. van Heijl
    • 1
  • H. Frima
    • 2
  • O. A. J. van der Meijden
    • 1
  • H. R. van den Berg
    • 3
  • A. H. van der Veen
    • 3
  • A. C. Gunning
    • 4
  • R. M. Houwert
    • 5
  • E. J. M. M. Verleisdonk
    • 1
    Email author
  1. 1.Diakonessenhuis UtrechtUtrechtThe Netherlands
  2. 2.Kantonsspital GraubündenChurSwitzerland
  3. 3.Catharina ziekenhuisEindhovenThe Netherlands
  4. 4.University Medical Center UtrechtUtrechtThe Netherlands
  5. 5.Utrecht TraumacenterUtrechtThe Netherlands

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