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.
Résumé
Fixation intramédullaire des fractures diaphysaires de la clavicule. 37 fractures de la partie médiophysaire de la clavicule chez 35 patients ont été traitées par une fixation intramédullaire par voie ascendante, en utilisant une vis spongieuse, de diamètre 6,5. L’âge moyen des patients était de 38 ans (entre 18 et 65). La vis a été insérée à partir du fragment interne après mêchage rétrograde. Le suivi moyen a été de 21 mois (entre 9 et 36 mois). Une consolidation radiologique a été effectuée dans tous les cas à partir de 6 à 8 semaines après l’intervention (moyenne de 7,8 semaines). 2 cas ont présenté un défaut de fixation peropératoire et 9 patients se plaignaient d’une gène secondaire à la proéminence de la vis, 5 de sensations désagréables au niveau de l’incision et 3 avaient des signes d’épaules gelées. En conclusion, cette technique simple et abordable ne nécessite pas d’instrumentation particulière, ni d’implants particuliers et permet une compression intramédullaire avec une bonne stabilité, une bonne répartition des contraintes et d’un dépériostage à minimum ainsi qu’une récupération rapide après l’intervention.
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Khalil, A. Intramedullary screw fixation for midshaft fractures of the clavicle. International Orthopaedics (SICOT) 33, 1421–1424 (2009). https://doi.org/10.1007/s00264-009-0724-2
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DOI: https://doi.org/10.1007/s00264-009-0724-2