Displaced Midshaft Clavicle Fractures: Minimally Invasive Osteosynthesis by Elastic Titnaium Nails

Introduction: Treatment of displaced midshaft clavicle fractures is controversial. Usually, nonoperative treatment is favored and leads to good results but the rate of nonunion may reach up to 15%, and a high rate of sequelae in up to 50% of the patients has been reported. The most prevalent method of operative fixation worldwide is ORIF with plate and screws. Since this method has numerous possible complications, such as infections, bulging hardware, implant failure and neurovascular injuries, a minimal invasive approach using Titanium Elastic Nails (TEN) was developed.

Methodes: Between January 2006 and March 2013, 26 patients (19 males, 7 female, age 14-52) with a displaced midshaft fracture of the clavicle were treated surgically by TEN fixation, 23 cases at the Soroka MC and 3 at Meir MC. Inclusion criteria were displaced (more 1.5 cm) mid-clavicular fractures in physically active patients. All fractures were operated within 2 weeks of arrival. 21 patients were injured in athletic activities, 5 were involved in a MVA’s. Outcome analysis included standard clinical follow-up, and plain radiographs.

Results: The fracture healed in the correct anatomical axis in all patients. All patients had full range of motion within 2–3 weeks without any hardware failure or infections. 3/28 patients (10.7%) developed transient neuropraxia due to stretching of Brachial Plexus that resolved spontaneously. 3/28 patients (10.7%) developed Keloid scarring that mandated plastic surgery intervention. A total of 6 nails were removed, 3 of which due to distal protrusion of the nail and 3 due to medial entry point irritation.

Conclusions: Operative fixation of displaced midshaft clavicular fracture by TEN achieved quick symptoms relief, with no malunion or nonunion and with no infections, and with the advantages of a safe minimal invasive procedure. This study supports primary osteosynthesis by TEN of displaced midshaft clavicular fractures in active adult patients.