Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning

BACKGROUND: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. METHODS: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. RESULTS: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. CONCLUSIONS: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.