Intramedullary screw fixation for midshaft fractures of the clavicle

Abstract

Open intramedullary fixation of 37 fresh midshaft clavicular fractures in 35 patients was performed using a 6.5 partially threaded cancellous screw. Mean age was 38 years (range 18-65). The screw was inserted from the medial fragment after retrograde drilling of that fragment. Average follow-up period was 21 months (range 9-36). Radiological evidence of union was apparent in all cases within six to eight weeks after surgery (mean 7.8). Two cases had intraoperative failure of fixation, nine complained of subcutaneous prominence of the screw head, five experienced decreased sensation over the site of incision, and three had symptoms of frozen shoulder. In conclusion, the technique is simple, affordable and it does not require special instrumentation or implants. It allows intramedullary compression, stability, stress sharing, minimal periosteal stripping, and early recovery after surgery.

Figures

Fig. 1

a–c Diagrams showing the steps in introduction of the screw

Fig. 2

a Radiograph showing a comminuted right midclavicular fracture. b The same case after fixation and union