Elastic titanium nails in minimally invasive osteosynthesis for midclavicular fractures

Background. In up to 31% of cases, conservative treatment of midclavicular fractures leads to unsatisfactory results. The aim of this study was to define the value of minimally invasive elastic stable intramedullary nailing (ESIN) of midclavicular fractures with titanium elastic nails. Material and Methods. Within 5 years, ESIN was perfomed in 45 patients. We studied the functional results and complications. Results. Retrospectively we analysed the results of all patients at a mean follow-up of 24.7±2.4 months. Iatrogenic perforation of the lateral cortex occurred twice and medial migration in eight patients. Superficial skin infection developed in one. Nail breakage after fracture healing was observed twice. Twelve patients sustained clavicular shortening of ≥5 mm in relation to the intact contralateral side. After 6 months the mean constant score was 94.3±2 points, and the mean DASH score was 5.4±2.2 points. Conclusion. Intramedullary stabilisation of midclavicular fractures with titanium elastic nails is a minimally invasive technique with good functional results. Patients must be informed about the possibility of open reduction in about half of the cases as well as shoulder asymmetry, migration of the nail, and iatrogenic nerve and vessel injury. © 2006 Springer Medizin Verlag.