From Nail to Fail: Complications Encountered with Clavicle Nailing - A Series of 3 Cases

Clavicle fractures are common injuries and the trend from non-operative management has been now changed toward operative management. Plate fixation after open reduction and intramedullary nail fixation after closed reduction are the standard operative management techniques. Nail fixation although has advantages of being minimally invasive, it has its own complications. This case series aims to report some of the complications observed in patients referred to our institution after undergoing intramedullary nail fixation of the clavicle at outside hospitals.

In this article, we present three patients who underwent closed reduction and intra-medullary nail fixation for displaced middle third clavicle fractures in an outside hospital and developed significant complications post-operatively. In the first case, the patient developed a delayed union of fracture with subsequent implant migration. In the second case, the patient developed a delayed union of fracture with nail bending, causing persistent pain and deformity. The third case presented with a neck abscess resulting from implant-related infection. Each patient was treated with a systematic approach of implant removal, followed by fixation with plate and screws, and appropriate antibiotic therapy for infection.

This case series highlights the potential complications associated with clavicle nailing, emphasizing the need for proper technique and research on implant design. Although clavicle nailing has the advantages of being minimally invasive with lesser soft tissue stripping, clavicle plating remains the gold standard as it provides more rigid fixation and promotes early rehabilitation and recovery. If clavicle nailing is being done, one must be aware of potential complications such as non-union, implant migration, hardware failure, and infections. Early referral and timely intervention are crucial for favorable outcomes.