Clavicular fractures are one of the most common injuries in adults, accounting for 2% to 5% of all fractures, and the incidence is twice as high in young men as in women, possibly because they are at significant risk of trauma. Treatment of clavicular fractures should be guided by the fracture location (middle 1/3, lateral or medial) and the fracture morphology (undisplaced, displaced or comminuted) . Current guidelines recommend surgical treatment for clavicular fractures of fully displaced, 2 cm of shortened or comminuted in the middle 1/3 third, as these may help to restore shoulder motion earlier and improve eventual shoulder function. In 2019, Guerra, et al. conducted a meta-analysis including 14 randomized controlled trials and 1 546 patients. They found that compared with nonoperative treatment, surgical treatment could remarkably reduce the rate of nonunion and shorten the fracture healing time for displaced mid-shaft clavicular fractures. Although the incidence of complications such as infection, nerve injury ,etc. were slightly higher, the shoulder function scored higher in the short term and long term follow-ups.

To compare the application of Nice knot assisted reduction (Nice knot fixed sphenoid fragment) and traditional reduction (screw fixed sphenoid fragment) in the treatment of adult displaced comminuted mid-shaft clavicular fracture (AO type 15-B2) , so as to provide reference for perioperative management in clinical practice.

From January 2017 to June 2019, a total of 47 cases with mid-shaft clavicular fractures (AO type 15-B2) were treated in our department with complete follow-ups, and the data were retrospectively analyzed. There were 22 cases in the Nice knot assisted reduction technique group, and 25 cases in the traditional reduction technique group. The operation duration, blood loss, VAS on the postoperative 2nd day, fracture healing time, postoperative complications and Neer scores of shoulder joint were analyzed and compared between two groups. The internal fixator complications included infection, internal fixator loosening, breakage and fragment displacement.

Forty-seven patients were followed up for 6-15 months after surgery, with an average time of (10.7±3.5) months. In the Nice knot assisted reduction technique group, the operation time was 50-80 min with an average time of (66.45±7.24) min, the intraoperative blood loss was 18-40 ml , (29.73±5.63 ) ml, the VAS score was 1-5 (2.95±1.21) points on the second day after surgery, the fracture healing time was 11 -18 weeks with an average of (13.91±1.74) weeks, and the Neer score of shoulder joint was 90-100 (94.55±3.00) points in the last follow-up. In the traditional reduction technique group, the operative time of the was 55-91 min with an average of (73.24±10.97) min, and the intraoperative blood loss was 20-50 ml with an average of (35.44±8.52) ml, the VAS score was 1-6 (2.88±1.36) points on the second day after surgery, the fracture healing time was 12-18 weeks with an average time of (14.08±1.78) weeks, and the Neer score of shoulder joint was 90-100 (94.28±2.75) points in the last follow-up. By comparison, the Nice knot assisted reduction group had shorter operation time and less intraoperative blood loss than those in the traditional reduction group (P<0.05) , while there were no statistically significant differences between the two groups in other evaluative indicators (P>0.05) . All the fractures in the two groups healed at the first stage. No internal fixator loosening, breakage or fragment displacement occurred.

The application of Nice knot assisted reduction in the treatment of displaced comminuted mid-shaft clavicular fractures shortened the operation time and reduced the intraoperative blood loss. The postoperative results were satisfactory. However, further multicenter, prospective, randomized controlled clinical studies are required to confirm and promote this technique.