J Korean Orthop Assoc.  2017 Feb;52(1):7-14. 10.4055/jkoa.2017.52.1.7.

Surgical Techniques for Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures

• Ha SS
• Sim JC
• Sung MC
• Jeon JH
• Seo YR

• KMID: 2369566
• DOI: http://doi.org/10.4055/jkoa.2017.52.1.7

Abstract

PURPOSE
To report the clinical results from surgical treatment for clavicle shaft fracture by percutaneous intramedullary fixation with Steinmann pins.
MATERIALS AND METHODS
Between January 2004 and June 2014, the medical records of 135 patients who underwent percutaneous intramedullary fixation with Steinmann pins were reviewed. The mean follow-up periods were 15 months. The functional results were evaluated with The Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant score. The clinical results were evaluated with the shortened length of the clavicle, length of surgical wound, operation time and Kang's criteria.
RESULTS
The mean bone union period was 11.6 weeks (8-16 weeks). The mean DASH score was 11.8. The mean Constant score was 91.2. The mean shortened length of the clavicle was less than 20 mm. The mean length of surgical wound was 1.2 cm (0.7-1.5 cm). The mean operation time was 18 minutes (10-35 minutes). Using Kang's criteria, 131 out of 135 patients (97.0%) showed good results. Complications included were 3 pin migrations and 2 non-unions.
CONCLUSION
Percutaneous intramedullary fixation with Steinmann pins showed good results for treating clavicle shaft fracture.

Keyword

clavicle; clavicle shaft fracture; intramedullary pin fixation

MeSH Terms

Arm
Clavicle*
Follow-Up Studies
Hand
Humans
Medical Records
Shoulder
Wounds and Injuries

Figure

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  Figure 1 Photograph (A) and radiograph (B) showing percutaneous insertion of a Steinmann pin into the intramedullary canal under fluoroscopic guidance from the fracture side to the medial end.

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  Figure 2 Photograph (A) and radiograph (B) showing a reduction of the clavicle fracture with a towel clip.

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  Figure 3 Photograph (A) and radiograph (B) showing retrograde reinsertion of a Steinmann pin under fluoroscopic guidance after fracture site reduction.

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  Figure 4 (A) Picture shows the displaced clavicle shaft fracture as Robinson classification type 2B1. (B) Immediate postoperative radiograph shows a well-reducted clavicle with percutaneous Steinmann pin fixation. (C) Radiograph from postoperative 12 weeks shows bone union.

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  Figure 5 In the functional assessment, postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score (A) and Constant score (B) change.

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  Figure 6 (A) Preoperative three-dimensional computed tomographic image showing a displaced clavicle shaft fracture with a double-butterfly fragment classified as Robinson type 2B2. (B) Immediate postoperative radiograph showing a well-reducted clavicle with double butterfly fragments with Steinmann pin fixation. (C) Radiograph from postoperative 12 weeks shows complete bone union with butterfly fragments and complete remodeling of the clavicle fractures.

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  Figure 7 Photograph showing surgical wound after percutaneous Steinmann pin fixation.

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  Figure 8 (A) Radiograph showing the bended Steinmann pin due to slip down. (B) Radiograph from postoperative 12 weeks shows bone union and remodeling without any other procedure.

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