Skip to main content
Erschienen in: MUSCULOSKELETAL SURGERY 1/2015

01.09.2015 | Original Article

Intramedullary clavicle fixation with single large fragmentary screw

verfasst von: S. G. Krishnan, R. Garofalo, B. Flanagin, A. Castagna

Erschienen in: MUSCULOSKELETAL SURGERY | Sonderheft 1/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

The treatment of clavicle fractures has historically been nonoperative, but several studies have recently shown the merits of operative management for specific fractures patterns. We developed a novel technique utilizing a 6.5-mm cannulated screw for fixation of displaced midshaft clavicle fractures.

Materials and methods

We present 15 consecutive patients treated with this technique between 2007 and 2012. All patients were male, and all 15 suffered a traumatic injury involving a fall directly onto the affected side. Mean time from injury to surgery was 12 days (range 3–24 days). Decision for surgery was based on the displacement and shortening of the fracture, either at least 20 mm of shortening or displacement with no bony apposition. After surgery, all patients were placed in an abduction brace for 6 weeks. No motion was allowed for the first 3 weeks, followed by passive shoulder motion below 90° of forward flexion under the supervision of a therapist for the next 3 weeks.

Results

All 15 patients progressed to union at an average of 5.7 months (range 3–12). Three patients had superficial wound infections. Hardware removal was performed in 6 of the 15 patients at an average of 12 months (range 5–24). All patients regained full range of motion and strength in comparison with contralateral extremity.

Conclusion

This novel technique limits soft tissue stripping. It has the advantages of using an implant familiar to most orthopedists and available in most hospital settings. We believe this technique is ideally suited for transverse fractures patterns, less than 14 days old, in males greater than 180 cm with clavicles large enough to accommodate a 6.5-mm screw.
Literatur
1.
Zurück zum Zitat McKee MD, Kreder HJ, Mandel S, McCormack R, Reindl R, Pugh D et al (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89:1–10 McKee MD, Kreder HJ, Mandel S, McCormack R, Reindl R, Pugh D et al (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89:1–10
2.
Zurück zum Zitat Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484CrossRefPubMed Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484CrossRefPubMed
3.
Zurück zum Zitat Zlowodski M, Zelle BA, Cole PA, Jeray K, McKee MD (2005) Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures. J Orthop Trauma 19:504–507CrossRef Zlowodski M, Zelle BA, Cole PA, Jeray K, McKee MD (2005) Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures. J Orthop Trauma 19:504–507CrossRef
4.
Zurück zum Zitat Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86:1359–1365PubMed Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86:1359–1365PubMed
5.
Zurück zum Zitat Sun JZ, Zheng GH, Zhao KY (2014) Minimally invasive treatment of clavicular fractures with cannulated screw. Orthop Surg 6(2):121–127CrossRefPubMed Sun JZ, Zheng GH, Zhao KY (2014) Minimally invasive treatment of clavicular fractures with cannulated screw. Orthop Surg 6(2):121–127CrossRefPubMed
6.
Zurück zum Zitat Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD (2007) Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elb Surg 16(3):280–284CrossRef Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD (2007) Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elb Surg 16(3):280–284CrossRef
7.
Zurück zum Zitat Richardson M, Asadollahi S, Richardson L (2013) Management of acute displaced midshaft clavicular fractures using Herbet cannulated screw: technique and results in 114 patients. Int J Shoulder Surg 7(2):52–58PubMedCentralCrossRefPubMed Richardson M, Asadollahi S, Richardson L (2013) Management of acute displaced midshaft clavicular fractures using Herbet cannulated screw: technique and results in 114 patients. Int J Shoulder Surg 7(2):52–58PubMedCentralCrossRefPubMed
9.
Zurück zum Zitat Nowak J, Holgersson M, Larsson S (2004) Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elb Surg 13:479–486CrossRef Nowak J, Holgersson M, Larsson S (2004) Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elb Surg 13:479–486CrossRef
10.
Zurück zum Zitat Denard PJ, Koval KJ, Cantu RV, Weinstein JN (2005) Management of midshaft clavicle fractures in adults. Am J Orthop 34(11):527–536PubMed Denard PJ, Koval KJ, Cantu RV, Weinstein JN (2005) Management of midshaft clavicle fractures in adults. Am J Orthop 34(11):527–536PubMed
12.
Zurück zum Zitat Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S (2011) Functional outcomes of conservatively treated clavicle fractures. Clinics 66(4):635–639PubMedCentralCrossRefPubMed Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S (2011) Functional outcomes of conservatively treated clavicle fractures. Clinics 66(4):635–639PubMedCentralCrossRefPubMed
13.
Zurück zum Zitat Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79:537–539CrossRefPubMed Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79:537–539CrossRefPubMed
14.
Zurück zum Zitat Kettler M, Schieker M, Braunstein V, Konig M, Mutschler W (2007) Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures. Acta Orthop 78:424–429CrossRefPubMed Kettler M, Schieker M, Braunstein V, Konig M, Mutschler W (2007) Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures. Acta Orthop 78:424–429CrossRefPubMed
15.
Zurück zum Zitat Wick M, Muller EJ, Kollig E, Muhr G (2001) Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg 121:207–211CrossRefPubMed Wick M, Muller EJ, Kollig E, Muhr G (2001) Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg 121:207–211CrossRefPubMed
16.
Zurück zum Zitat Chu CM, Wang SJ, Lin LC (2002) Fixation of mid-third clavicular fractures with Knowles pins: 78 patients followed for 2–7 years. Acta Orthop Scand 73:134–139CrossRefPubMed Chu CM, Wang SJ, Lin LC (2002) Fixation of mid-third clavicular fractures with Knowles pins: 78 patients followed for 2–7 years. Acta Orthop Scand 73:134–139CrossRefPubMed
17.
Zurück zum Zitat Chuang T, Ho W, Hsieh P, Lee P, Chen C, Chen Y (2006) Closed reduction and internal fixation for acute midshaft clavicular fractures using cannulated screws. J Trauma 60:1315–1321CrossRefPubMed Chuang T, Ho W, Hsieh P, Lee P, Chen C, Chen Y (2006) Closed reduction and internal fixation for acute midshaft clavicular fractures using cannulated screws. J Trauma 60:1315–1321CrossRefPubMed
18.
Zurück zum Zitat Grassi FA, Tajana MS, D’Angelo F (2001) Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma 50:1096–1100CrossRefPubMed Grassi FA, Tajana MS, D’Angelo F (2001) Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma 50:1096–1100CrossRefPubMed
19.
Zurück zum Zitat Bostman O, Manninen M, Pihlajamaki H (1997) Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 43:778–783CrossRefPubMed Bostman O, Manninen M, Pihlajamaki H (1997) Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 43:778–783CrossRefPubMed
20.
Zurück zum Zitat Poigenfurst J, Rappold G, Fischer W (1992) Plating of fresh clavicular fractures: results of 122 operations. Br J Accid Surg 23:237–241 Poigenfurst J, Rappold G, Fischer W (1992) Plating of fresh clavicular fractures: results of 122 operations. Br J Accid Surg 23:237–241
21.
Zurück zum Zitat Boehme D, Curtis RJ, DeHaan JT, Kay SP, Young DC, Rockwood CA Jr (1991) Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am 73:1219–1226PubMed Boehme D, Curtis RJ, DeHaan JT, Kay SP, Young DC, Rockwood CA Jr (1991) Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am 73:1219–1226PubMed
22.
Zurück zum Zitat Mueller M, Burger C, Florczyk A, Striepens N, Rangger C (2007) Elastic stable intramedullary nailing of midclavicular fractures in adults. Acta Orthop 78:421–423CrossRefPubMed Mueller M, Burger C, Florczyk A, Striepens N, Rangger C (2007) Elastic stable intramedullary nailing of midclavicular fractures in adults. Acta Orthop 78:421–423CrossRefPubMed
23.
Zurück zum Zitat Thyagarajan DS, Day M, Dent C, Williams R, Evans R (2009) Treatment of mid-shaft clavicle fractures: a comparative study. Int J Shoulder Surg 3(2):23–27PubMedCentralCrossRef Thyagarajan DS, Day M, Dent C, Williams R, Evans R (2009) Treatment of mid-shaft clavicle fractures: a comparative study. Int J Shoulder Surg 3(2):23–27PubMedCentralCrossRef
24.
Zurück zum Zitat Fransen P, Bourgeois S, Rommens J (2007) Kirschner wire migration causing spinal cord injury one year after internal fixation of a clavicle fracture. Acta Orthop Belg 73:390–392PubMed Fransen P, Bourgeois S, Rommens J (2007) Kirschner wire migration causing spinal cord injury one year after internal fixation of a clavicle fracture. Acta Orthop Belg 73:390–392PubMed
25.
Zurück zum Zitat Wada S, Noguchi T, Hashimoto T, Uchida Y, Kawahara K (2005) Successful treatment of a patient with penetrating injury of the esophagus and brachiocephalic artery due to migration of Kirschner wires. Ann Thorac Cardiovasc Surg 11:313–315PubMed Wada S, Noguchi T, Hashimoto T, Uchida Y, Kawahara K (2005) Successful treatment of a patient with penetrating injury of the esophagus and brachiocephalic artery due to migration of Kirschner wires. Ann Thorac Cardiovasc Surg 11:313–315PubMed
26.
Zurück zum Zitat Parsons M, Blitzer CM (2005) Small-incision, intramedullary compression osteosynthesis of acute and non-united midshaft clavicle fractures. Tech Shoulder Elb Surg 6:218–225CrossRef Parsons M, Blitzer CM (2005) Small-incision, intramedullary compression osteosynthesis of acute and non-united midshaft clavicle fractures. Tech Shoulder Elb Surg 6:218–225CrossRef
Metadaten
Titel
Intramedullary clavicle fixation with single large fragmentary screw
verfasst von
S. G. Krishnan
R. Garofalo
B. Flanagin
A. Castagna
Publikationsdatum
01.09.2015
Verlag
Springer Milan
Erschienen in
MUSCULOSKELETAL SURGERY / Ausgabe Sonderheft 1/2015
Print ISSN: 2035-5106
Elektronische ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-015-0356-1

Weitere Artikel der Sonderheft 1/2015

MUSCULOSKELETAL SURGERY 1/2015 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.