Clinical application of robot-assisted and retrograde elastic intramedullary nail in the minimally invasive treatment of displaced midshaft clavicle fractures
Objective To evaluate the clinical efficacy of robot-assisted retrograde intramedullary nail in the treatment of midshaft clavicle fractures.Methods All patients who were diagnosed with displaced midclavicular fractures at Beijing Jishuitan Hospital,Capital Medical University from December 1,2022 to May 31,2023 and met the inclusion and exclusion criteria were included in this prospective study.All procedures were navigated and planned by an experienced surgeon using the new TIANJI robotic system for optimal retrograde intramedullary nail entry points and trajectories.The demographics and intraoperative parameters of the patients were recorded.Clinical follow-up was performed at 2 week,4 week,6 week,8 week,12 week,6 month and 12 month,respectively.Fracture healing time was assessed by an orthopedic surgeon and a rehabilitation therapist with the Constant Murley Shoulder(CM)score,quick Disabilities of the Arm,Shoulder and Hand(q-DASH)score for the arm,shoulder,and hand,the Scar Cosmesis Assessment and Rating(Scar)Scale,and the Visual Analogue Scale(VAS).Results A total of 60 patients[48 males and 12 females,aged(32.97±11.26)years]were included.Injury causes:18 cases fell while walking,32 cases fell while riding electric or motorcycle,4 cases were injured by car,and 6 cases were injured in sports.According to AO classification,there were 16 cases of type A,26 cases of type B and 18 cases of type C.The operation time was(53.47±21.63)min,with closed reduction in 50 cases and local limited open reduction in 10 cases.All patients were followed up for(60.50±6.69)week.The fracture healing time was(7.43±2.19)week.Compared with the healthy side,the clavicle shortening rate was significantly improved from(6.44±5.00)%before surgery to(2.09±2.95)%after surgery(P<0.01).The recovery range time of shoulder activity was(9.13±2.20)week,and the recovery exercise time was(12.73±2.39)week.All patients were satisfied with the Scar,and the Scar score was 9.80±0.48.CM scores at 2 week,6 week and 6 month were 53.67±9.52,83.22±6.28 and 97.85±2.60,respectively.q-DASH scores at 2 week,6 week,and 6 month were 33.17±5.37,17.07±5.37,and 11.42±0.69,respectively.Skin pain caused by nail protrusion occurred in 5 cases(8.33%),and transient nerve plexus irritation occurred in 1 case(1.67%),which disappeared 28 week after operation.Conclusion Robot-assisted retrograde elastic intramedullary nail is a safe and minimally invasive surgery for the treatment of displaced midshaft clavicle fractures,with the advantages of fast healing,good aesthetics,good functional prognosis and few complications.
clavicle fracturerobotnavigationintramedullary nail
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