title: Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood Clavicle Pin.
abstract: BACKGROUND
  Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing.
  
  
  OBJECTIVE
  We asked the following questions: (1) Does use of the Rockwood Clavicle Pin (DePuy Orthopaedics Inc, Warsaw, IN) predispose patients to soft tissue complications requiring additional surgery or a high infection risk? (2) Does the Rockwood Clavicle Pin provide a truly minimally invasive insertion technique and reliable fracture fixation?
  
  
  METHODS
  We retrospectively evaluated 18 patients (mean age, 31 years) who sustained a closed midshaft fracture of the clavicle treated with open intramedullary nailing with a Rockwood Clavicle Pin. We determined the incidence of complications and rate of fracture healing.
  
  
  RESULTS
  Fourteen complications occurred in 10 patients. Five patients experienced a complication with fracture healing, including three nonunions. Nine patients experienced complications relating to soft tissue, including infection, skin necrosis, or posterior pain from pin prominence.
  
  
  CONCLUSIONS
  The Rockwood Clavicle Pin remains a historically relevant method of clavicle fixation. However, due to an unacceptably high rate of nonunion, repeat operation, and soft tissue complications, we do not recommend this device for treating middiaphyseal clavicle fractures.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue at Grand Boulevard, Saint Louis, MO 63110, USA. muddcd@slu.edu
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mudd
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Quigley
authors.forename: Lyndon B
authors.initials: LB
authors.lastname: Gross
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D003646:Debridement; D004867:Equipment Design; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology; D055815:Young Adult