Robot-Assisted Retrograde Elastic Intramedullary Nailing Versus ORIF with a Plate for Displaced Midshaft Clavicular Fractures.

Abstract

Background: The objective of this study was to compare the clinical outcomes of robot-assisted retrograde elastic intramedullary nailing and open reduction and internal fixation (ORIF) with a plate for displaced midshaft clavicular fractures.

Methods: All patients diagnosed with displaced midshaft clavicular fractures between November 1, 2022, and June 30, 2023, in our level-III hospital (most advanced level) were enrolled in this retrospective study; a total of 116 patients met the inclusion criteria. Patients were divided into 2 groups on the basis of treatment: robot-assisted retrograde elastic intramedullary nailing (RAN group) and ORIF with a plate (plate group). Operations in the RAN group were carried out using the novel TIANJI Robot system (TINAVI Medical Technologies) for navigation and planning of the optimal retrograde intramedullary nailing trajectory. Patient demographics, perioperative parameters, and complications were documented. Patients were followed at the trauma clinic for clinical and radiographic assessment.

Results: There were 74 patients in the RAN group and 42 patients in the plate group. The RAN group exhibited a significantly shorter total operative time (mean, 52.20 ± 20.76 versus 86.83 ± 27.42 minutes), less blood loss (mean, 7.38 ± 5.54 versus 59.05 ± 30.11 mL), shorter incision length (mean, 1.28 ± 0.85 versus 9.79 ± 1.63 cm), and shorter duration of hospital stay (mean, 3.38 ± 0.73 versus 5.50 ± 1.99 days) (all p < 0.05). Nail treatment was also associated with a significantly shorter time to bone union (mean, 7.92 ± 2.46 versus 16.79 ± 5.18 weeks), a higher SCAR score (mean, 9.77 ± 0.51 versus 5.74 ± 1.15), a shorter time to return to sports (mean, 12.70 ± 2.35 versus 20.10 ± 4.10 weeks), and a shorter time to regain full range of shoulder motion (mean, 9.46 ± 2.35 versus 12.05 ± 2.95 weeks) (all p < 0.05). At the final follow-up, the Constant-Murley shoulder score was significantly higher in the RAN group (mean, 97.57 ± 2.77 versus 93.29 ± 7.63) (p < 0.05). Compared with the RAN group, the plate group had more complications (p < 0.05).

Conclusions: Robot-assisted retrograde elastic intramedullary nailing is a safe and minimally invasive treatment option for displaced midshaft clavicular fractures that promotes rapid healing, good cosmesis, excellent functional outcomes, and fewer complications compared with ORIF with a plate.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.