title: Association between screw prominence and vascular complications after clavicle fixation.
abstract: BACKGROUND
  Fixation of clavicle fractures has become more common to prevent symptomatic malunion and nonunion. The subclavian and axillary vessels are in close proximity to the medial two-thirds of the clavicle, placing them at risk from prominent metalware. Injury to these major vessels has the potential to be life or limb-threatening. Despite this anatomical risk, iatrogenic vascular injury associated with clavicle fixation is rare.
  
  
  OBJECTIVE
  The aim of this study was to identify risk factors associated with modern fixation techniques in reported cases of vascular injury after clavicle fixation.
  
  
  METHODS
  A literature search was performed, and all identified cases of iatrogenic vascular injury associated with prominent clavicle fixation were analyzed. Clinical details, the total length of the prominent screws and the distance that they protruded from the far cortex were recorded.
  
  
  RESULTS
  Five cases were identified; there were four pseudoaneurysms and one arteriovenous fistula. The total length of the offending screw was identifiable in two cases, measuring 26 and 30 mm. The length of screw prominence was identifiable in 3 cases (8, 10 and 10 mm). The pseudoaneurysms presented at 2-10 years following clavicle fixation. Three of these cases developed limb-threatening ischemia.
  
  
  CONCLUSIONS
  Vascular complications associated with clavicle fixation are uncommon but potentially limb-threatening. Several associated factors are identified. The authors provide a number of detailed recommendations aimed at preventing these complications.
authors.affiliation: Department of Orthopaedics, Monash Medical Centre, Moorabbin, Victoria, Australia ; Melbourne Shoulder & Elbow Centre, Brighton, Victoria, Australia ; Department of Orthopaedic Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Harry D S
authors.initials: HD
authors.lastname: Clitherow
authors.affiliation: Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, SA, Australia ; Department of Orthopaedic Surgery, Flinders University, Adelaide, SA, Australia.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Bain
keywords: Arteriovenous fistula; axillary artery; clavicle fracture; complication; internal fixation; risk factor; subclavian artery