Management of Acute Displaced Midshaft Clavicular Fractures Using Herbert Cannulated Screw: Technique and Results in 114 Patients

Overview

Journal Int J Shoulder Surg

Date 2013 Aug 21

PMID 23960363

Citations 4

Authors

Martin Richardson

Saeed Asadollahi

Louise Richardson

Affiliations

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Abstract

Purpose: A new and simple operative technique has been developed to provide internal fixation for midshaft clavicle fractures. This involves the use of a large fragment Herbert Screw that is entirely embedded within the bone. Screw fixation is combined with bone grafting from intramedullary reamings of the fracture fragments. The purpose of this report is to assess the outcomes following treatment of midshaft clavicular fracture using this method.

Materials And Methods: One hundred and fourteen patients with acute displaced midshaft fracture were identified between 2002 and 2007. All patients were followed until fracture union. Patients' medical records were reviewed. Disability of the Arm, Shoulder, and Hand questionnaire (DASH), and American Shoulder and Elbow Surgeons Elbow form (ASES) were posted to all patients. Outcome measures included union rate, time to union, implant removal rate, DASH, and ASES scores.

Results: Patients' median age was 29.5 years (interquartile range, 19-44 years). The most common injury mechanism was sports injury (28%). The median time from injury to surgery was 5 days (interquartile range, 2-9 days). Union occurred in an average of 8.8 weeks. Non-union occurred in three cases (2.6%). The re-operation rate for symptomatic hardware prominence screw was 1.7%. The median DASH score was 0.83 and the median ASES was 100 (n = 35).

Conclusions: Intramedullary fixation using cannulated Herbert screw can be used as an effective approach for operative management of midshaft clavicular fractures. Using this method, an appropriate outcome could be achieved and a second intervention for implant removal could be avoided in great majority of cases.

Level Of Evidence: Level III.

Citing Articles

Finite element analysis of spiral plate and Herbert screw fixation for treatment of midshaft clavicle fractures.

Zhang X, Cheng X, Yin B, Wang J, Li S, Liu G Medicine (Baltimore). 2019; 98(34):e16898.

PMID: 31441868 PMC: 6716701. DOI: 10.1097/MD.0000000000016898.

Prospective randomized study comparing results of fixation for clavicular shaft fractures with intramedullary nail or locking compression plate.

Calbiyik M, Ipek D, Taskoparan M Int Orthop. 2016; 41(1):173-179.

PMID: 27138609 DOI: 10.1007/s00264-016-3192-5.

Minimally invasive implantation of a novel flexible intramedullary nail in patients with displaced midshaft clavicle fractures.

Calbiyik M, Zehir S, Ipek D Eur J Trauma Emerg Surg. 2015; 42(6):711-717.

PMID: 26319056 DOI: 10.1007/s00068-015-0567-z.

Intramedullary clavicle fixation with single large fragmentary screw.

Krishnan S, Garofalo R, Flanagin B, Castagna A Musculoskelet Surg. 2015; 99 Suppl 1:S25-30.

PMID: 25957543 DOI: 10.1007/s12306-015-0356-1.

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