title: Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: technique and results in 87 patients.
abstract: BACKGROUND
  Elastic, stable intramedullary nailing (ESIN) with titanium nails is a promising minimally treatment for displaced midclavicular fractures, which may be an alternative to plate fixation (ORIF) or even nonoperative treatment. We describe the surgical technique and outcome in 87 patients.
  
  
  METHODS
  The nail was inserted at the medial inferior end of the clavicle in 83 patients and in the acromial end in 12 patients. An open fracture reduction via an additional small incision was necessary in 53 patients and closed manoeuvre was successful in 42. Implant removal was performed in 82 patients.
  
  
  RESULTS
  The functional status of 87 patients after 13 months reached 6.8 (0-43) points on the DASH score and 81 (46-100) points on the self-reported Constant score. The fracture healed in correct anatomical axis in 80 of 87 patients, 2 cases ended in a nonunion. Implant migration of the nail occurred in 4 patients, who required early implant removal. Repeated nailing was necessary in 2 patients in whom the nail missed the lateral medullar canal, and plate fixation was necessary in 2 other patients who had secondary dislocation after early nail removal.
  
  
  CONCLUSIONS
  Flexible intramedullary nailing, a minimally invasive technique for stabilization of displaced midshaft clavicle fractures, has minor risks and complications.
authors.affiliation: Department of Surgery-Innenstadt, University Hospital of Munich, Munich, Germany. mark.kettler@gmx.de
authors.forename: Mark
authors.initials: M
authors.lastname: Kettler
authors.forename: Matthias
authors.initials: M
authors.lastname: Schieker
authors.forename: Volker
authors.initials: V
authors.lastname: Braunstein
authors.forename: Matthias
authors.initials: M
authors.lastname: König
authors.forename: Wolf
authors.initials: W
authors.lastname: Mutschler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011859:Radiography; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium