New device for clavicle fracture fixation

Posted on 2 January 2020

According to the University of Stellenbosch, history was made earlier this year when Dr Reggie King, an Orthopaedic Spinal Surgeon at the SpineCentre operating at Mediclinic Paarl, became the first individual in the Faculty of Medicine and Health Sciences (FMHS) to receive his PhD in Orthopaedic Surgery. Dr King’s PhD was entitled ‘The management of clavicle shaft fractures – evaluating the ability of a novel locked intramedullary device to achieve union and restore function of the shoulder’.

Dr King’s supervisor, Professor Rob Lamberts, Head of Research and Research within the Division of Orthopaedic Surgery at the University of Stellenbosch, was delighted with the achievement, “There are only about five orthopaedic surgeons in South Africa who have a PhD – so it is truly an exceptional achievement.”

According to Dr King, the research element of medicine is vital. “Medicine is an ever-expanding field.  Particularly in the field of orthopaedic surgery, improvements in technology have led to better implants and surgical techniques. This in turn leads to better patient outcomes. This is only possible as a result of clinical research – these devices must be evaluated in a clinical, practical setting to make sure that it will lead to superior clinical outcome.”

“My research focused on the management of displaced and shortened clavicle shaft fractures with a novel intramedullary device,” Dr King explains. “We evaluated the new device to determine how treatment outcome compares to patients managed with traditional plating. We did a series of studies, that have been published in international journals, to firstly determine whether clavicle fractures are common in our setting, whether the technique is viable, then to describe the surgical technique and then finally to compare the technique to traditional plating in a randomised controlled trial.” More than 1200 patients with displaced and shortened clavicle shaft fractures participated in the research.

Traditionally most displaced clavicle fractures are treated with a plate and screw construct. This leads to prominent hardware right under the skin that then needs to be removed once the fracture is healed.  New devices have since been developed that are placed over the fracture site, inside the bone within the medullary canal (intramedullary devices), which are then not prominent under the skin. Dr King explains that these devices are not very stable and tend to migrate, with some potentially disastrous consequences. “The new device that I worked with is unique in that it is locked into place with an interlocking screw and expandable grippers to prevent rotation and migration. This leads to a very stable construct.”

The advancement was made as a response to this patient dissatisfaction following treatment with plating, which then led me to consider an alternative method. He explains that for patients, the prominent subcutaneous hardware through traditional plating of clavicle shaft fractures may lead to skin irritation and discomfort, requiring removal of the plate. Most patients, particularly females, are dissatisfied by the cosmetic result with a large prominent scar over the collar bone. His device now offers a solution to these challenges.

According to Dr King they were able to demonstrate that the novel intramedullary device had similar union rates and functional outcomes to traditional plating, but with positive outcome of a smaller surgical wound and shorter surgical time needed to implant the device. There is also no prominent subcutaneous hardware and no risk of migration making a second operation to remove hardware (as is the case with plating), unnecessary. As one of the most common injuries in young, active individuals, this innovation will prove beneficial to a large number of patients.

Following this achievement within the FMHS, he believes that his keen interest in spinal surgery and his investment in his career in private practice will only further support his interest in remaining part of the academic sector, where he intends to focus more on spinal surgery research on a part time basis. “I enjoy academic medicine and believe in lifelong learning,” he concludes.

 

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