Midshaft clavicular fractures: comparison of intramedullary pin and plate fixation

Intramedullary pin and plate fixation for midshaft clavicular fractures both have their proponents, but little comparative data are available. We performed a retrospective comparison of these 2 techniques.

A retrospective review was performed on 40 consecutive patients with closed, simple, or wedge-type midshaft clavicular fractures that were identified from a prospectively collected orthopedic trauma database. Eight patients were excluded due to incomplete follow-up. Intramedullary pins were used in 18 patients and plates in 14; of these, 7 plates were placed superiorly, 6 anteriorly, and 1 inferiorly. Treatment method was determined by preference of the treating surgeon.

Among the patients treated with intramedullary pin fixation, all 18 fractures healed, and each underwent a planned procedure for pin removal. Complications included 1 intraoperative pin breakage, 1 superficial wound infection, 2 prominent symptomatic pins, and 1 transient brachial plexopathy. Among the patients treated with plating, delayed union occurred in 1, and refractures occurred in 2 (1 required a second procedure). Three patients underwent plate removal for symptomatic hardware. No patients in either group had significant loss of shoulder motion.

Intramedullary pin fixation for acute, simple, or wedge-type midshaft clavicular fractures provides a safe and predictable alternative to plate and screw fixation.