Intramedullary Nailing of Midclavicular Fractures with an Elastic Titanium Nail

Abstract

Objective:

Reduction and intramedullary fixation of midclavicular fractures with an elastic titanium nail with the goal to reduce pain and to quickly resume activities of daily living postoperatively.

Indications:

Midclavicular fractures types A and B according to the OTA (Orthopaedic Trauma Association) classification of fractures.

Contraindications:

Surgery > 3 weeks after trauma. Fractures type C according to the OTA classification. Osteoporosis.

Surgical Techique:

Skin incision just above the sternal end of the clavicle. Approximately 1 cm lateral to the sternoclavicular joint, a hole is drilled into the anterior cortex. A titanium nail varying in diameter between 2.5 to 3.5 mm is mounted on a universal chuck with a T-handle. With oscillating movements the titanium nail is advanced until it reaches the fracture site. If closed reduction maneuvers are unsuccessful, an additional skin incision has to be made at the level of the fracture site enabling direct manipulation of the fragments.

Postoperative Management:

Postoperatively, no immobilization is performed. Patients are encouraged to move the arm as much as tolerated and to use it in daily activities.

Results:

Intramedullary fixation was applied to 136 clavicle fractures in 132 patients (89 men, 43 women, mean age 32.9 years). In 78 fractures closed reduction was successful. Average subjective pain assessment using a visual analog scale decreased from 72.4 points preoperatively to 18.9 points 3 days postoperatively. Average shoulder abduction increased significantly. The average Constant-Murley clinical outcomes score 1 year after implant removal was 97.1 points.