Complications of clavicle fractures treated with intramedullary fixation

Hypothesis: Recent studies have demonstrated better outcomes with operative fixation of displaced midshaft clavicle fractures. We hypothesize that the risk of major complication with intramedullary fixation for clavicle fractures will be low.

Materials and methods: Clavicle fractures in 58 patients were treated with intramedullary fixation. Patients were excluded for concomitant pathologies and prior surgery status. Data collected included age, gender, treatment, fracture location, time of pin removal, type of complication, dates of further surgery, and American Shoulder and Elbow Surgeons (ASES) score. Complications were grouped into major (infection, nonunion, malunion) and minor (skin erosion, painful hardware, hardware breakage without consequence) categories. The mean age at surgery was 38 years (range, 18-67 years). All pins were removed at an average of 67 days (95% confidence interval, 54-85).

Results: Of the 58 patients, 15 (25.8%) complications occurred in 14 patients (24.1%). Five (8.6%) were classified as major (5 nonunions requiring revision surgery). Ten (17.2%) were classified as minor (1 delayed union, 2 superficial wound infections, 2 hardware failures after union, 5 skin erosions with pin exposure but without significant infection). Postoperative ASES scores average 89 at a mean follow-up of 7 years.

Discussion: Complete union and function were achieved in most patients, with an 8.6% risk of major complication. Intramedullary fixation has the potential for early but temporary hardware prominence, hardware exposure, and a slightly higher incidence of nonunion.

Conclusion: Patients with intramedullary fixation can expect smaller scars, no long-term hardware complications, and small potential for refracture or further hardware-related complications after hardware removal.