Percutaneous pinning of displaced midshaft clavicle fractures

Fractures of the clavicle are common and seen across all age groups. The traditional treatment of midshaft clavicle fractures has been conservative. Although minimally displaced fractures do well, recent outcome studies have shown higher incidences of fracture malunion, nonunion, and patient dissatisfaction after conservative treatment of displaced midshaft clavicle fractures than previously recognized. In this article, we present a surgical technique for anterograde pinning of displaced midshaft clavicle fractures. For the past 3 years, 24 patients with displaced clavicle fractures have been stabilized with a flexible titanium nail. Twenty-one patients have been followed to radiographic and clinical union, whereas 3 were lost to follow-up. All 21 fractures healed after the index procedure. There was 1 delayed union and 3 malunions. One malunion required revision surgery with placement of a structural bone graft. Six patients underwent elective pin removal secondary to skin irritation at the pin site. There were no cases of pin migration. Percutaneous pinning of selected displaced clavicle fractures offers a means of minimally invasive fixation that allows for early range of motion and function and a lower rate of fracture nonunion and malunion compared with conservative treatments. The risks of painful hardware, infection, and nonunion often associated with open reduction and internal fixation can be minimized with percutaneous pin fixation.