Slovenská chirurgia 3-4e/2024
Minimally invasive intramedullary osteosynthesis of the middle third clavicle fractures
For a long time, the preferred method of treatment of clavicle fractures was conservative. As a result of new findings, the indications for operative treatment have expanded. Mainly due to the findings of a significantly higher incidence of symptomatic nonunion in patients treated conservatively than previously reported. However, the treatment of clavicle fractures is still a controversial topic and authors‘ views differ. In general, it can be evaluated that most authors indicate to surgical management of fractures with dislocation and shortening over 2 cm, or when there is a threat of skin perforation or damage to other structures. In the operative management there is a possibility of using plate osteosynthesis or intramedullary stabilization of the fracture. The use of simple intramedullary osteosynthesis of the clavicle by a minimally invasive approach and the use of a wire, if properly indicated, allows comparable results to other techniques. At the same time, there is only minimal damage to the soft tissues. The minimally invasive approach leaves a more aesthetically pleasing scar in a visible area of the body. This type of osteosynthesis can be safely indicated especially for simple fractures of the middle third of the clavicle. In the 20-year period from 2003 to 2022, we operated on 42 patients with this technique at our department. 41 patients (32 men and 9 women) were evaluated. The mean age in the cohort was 28 years. In 40 cases (97.6%) the fracture healed without complications. In one case, we had to surgically treat a symptomatic nonunion. Subsequently, the fracture healed.
Keywords: fracture of clavicle, intramedullary osteosynthesis
