Summary

The aim is to present a method of intramedullary fixation of midshaft clavicle fractures with a cancellous screw

Abstract

Clavicle fractures account for 2.6-3% of closed fractures of the tubular bones and are typical for persons of young working age. Fractures of the middle third account for 75%, lateral 20%, and medial 5% of all clavicle fractures. Most often, the treatment of these injuries requires open reduction and internal fixation with internal fixation, or much less often an external fixation device is used.
Intramedullary fixation of clavicle fractures has not found proper application due to the S-shape form of the medullary canal and the migration of the intramedullary implant. Axial and rotational instability of the “bone-implant” system is also considered to be a traditional disadvantage of intramedullary osteosynthesis. The use of a cancellous screw for clavicle fractures in most cases eliminates these shortcomings.
The aim is to present

Method

of intramedullary fixation of midshaft clavicle fractures with a cancellous screw.
The author analyzed the results of surgical and conservative treatment of 114 patients aged 20-73 years (mean age 47.4±1.1 years) with midshaft fractures of the clavicle. Male was – 71 (62.2%), female – 43 (37.8%). According to AO/ASIF classification, the fracture was type ? (simple: a single circumferential disruption) – 61 (53.5%); type ? (wedge: contact between the main fragments after reduction usually restoring the normal length of the bone) – 48 (42.1%); type ? (multifragmentary: many fracture lines and fracture fragments) – 5 (4.4%). According to the method of treatment, all patients were divided into 2 groups (1 - surgical and 2 - conservative treatment). There were 65 (57%) patients treated surgically and 49 (43%) patients treated conservatively. The method of surgical treatment was intramedullary osteosynthesis with a cancellous screw, and the method of conservative treatment was 8-bandage and simple splint. The results of treatment were assessed using the DASH score. The average follow-up was 59.2±0.4 months (from 1 to 9 years) after trauma.
In the surgical treatment group, the postoperative period was without complications. The screw was removed 1.5-2 months after surgery through a small incision in the projection of the screw head. All patients achieved a physiological range of motion and a satisfactory cosmetic result. Complications were observed in 8 (12.3%) patients and were associated with an inability to remove the screw due to late hospitalization of the patient more than 3 months after surgery.
In the conservative treatment group complications were at 23 (46.9%) patients. The most common complication in the conservative treatment group was malunion (7 patients), angulation (16 patients), shortening (11 patients), and poor cosmetic result (15 patients). 8 patients had several complications simultaneously. But even with malunion, patients have good function. 6 patients with malunions have neurologic problems, and 3 patients have functional problems.
Thus, the use of a cancellous screw for primary intramedullary fixation of midshaft clavicle fractures meets the requirements of stable-functional osteosynthesis and has a positive effect on the rehabilitation of the patient, who is able to perform light physical labor 2-3 weeks after the surgery. According to the results of treatment of 114 patients in both groups with midshaft clavicle fractures, positive results were obtained in 79.8% (p<0.001) of cases.
Keywords: clavicle, fractures, intramedullary fixation, screw fixation, treatment.