Minimally invasive treatment of clavicular fractures with cannulated screw

Abstract

Objective: To evaluate minimally invasive treatment of clavicular fractures with cannulated screw.

Methods: Data of 65 patients who had undergone minimally invasive treatment with cannulated screws for clavicular fractures from April 2009 to October 2010 were retrospectively analyzed and compared with those of 65 patients with clavicular fractures who had been treated by the same surgeons with plates. In the study group, there were 41 males and 24 females, aged from 19-67 years (mean, 35.8 years). According to Craig's classification, there were 29 group 1 and 36 of group 2-II. Neer scores were used to evaluate shoulder function and radiographs to assess fracture union.

Results: The incision length was 4-5 cm in the cannulated screw group (CSG) and 10-11 cm in the reconstructive plate group (RPG). Radiographs showed bone union was achieved in both groups, the bone healing time being 13.2 ± 6.9 weeks in the CSG and 16.3 ± 8.7 weeks in the RPG. All patients were followed up for 6 to 20 months (average, 10.6 months). The average Neer score was 96.6 ± 3.4 in the CSG and 94.2 ± 5.8 in the RPG. In the CSG, screw loosening occurred in five, and fracture displacement in three. There was a significant difference in fracture healing time between two groups but not in Neer score.

Conclusion: Minimally invasive treatment of clavicular fractures with cannulated screws has the advantages of minimal invasion, short bone healing time, good clinical outcomes, and being relatively inexpensive.

Keywords: Bone; Bone screws; Clavicle; Fractures; Intramedullary.

© 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Figures

Figure 1

Craig 1 type fracture, the inner and outer diameters of the medullary cavity of the clavicle were measured with CT in a horizontal position; because the diameter of the proximal end was smaller, it was chosen to be the reference standard. Len, length. (a) Measurement of the inner and outer diameters of the medullary cavity of the proximal end of the fracture. Len, length. (b) Measurement of the inner and outer diameters of the medullary cavity of the distal end of the fracture. Len, length.

Figure 2

Craig 2‐II type fracture, the inner and outer diameters of the medullary cavity of the clavicle were measured with CT in a horizontal position; because the diameter of the proximal end was smaller, it was chosen to be the reference standard. Len, length. (a) Measurement of the inner and outer diameters of the medullary cavity of the proximal end of the fracture. Len, length. (b) Measurement of the inner and outer diameters of the medullary cavity of the distal end of the fracture. Len, length.

Figure 3

Schematic diagram of intramedullary fixation of a clavicular fracture with a cannulated screw. (a) The guiding device has been pushed into the medullary cavity of the distal fractured end, then the guide pin inserted and pushed out posterior to the acromion. (b) The fractured bone has been set, then the guide pin pushed back into medullary cavity of the proximal fractured end and the cannulated screw screwed in along the guide pin after tapping. (c) The clavicular fracture is fixed.

Figure 4

Man, 25 years old, left‐side clavicle Craig 2‐II fracture. (a) Preoperative orthophoric X‐ray film showed splintered fracture medial to coracoclavicular ligament (Craig 2–II). (b) The diameter of the medullary cavity of the proximal fractured end was measured preoperatively with CT in horizontal section. Len, length. (c) Postoperatively, an X‐ray film shows good alignment of the clavicle after reduction. (d) Postoperatively, CT in horizontal section showed satisfactory reduction and good position of the screw in the medullary cavity.