Functional Outcomes of Retrograde Intramedullary Screw Nailing for Displaced Midshaft Clavicle Fractures in Adults

Background  Midshaft clavicle fractures are quite common among clavicle injuries in adults. Although traditionally managed conservatively, displaced fractures often lead to nonunion, malunion, and shoulder dysfunction. While plate fixation offers strong stabilization, it requires a large incision and extensive soft-tissue dissection. Intramedullary fixation has become a minimally invasive alternative, but earlier devices such as Kirschner wires and elastic stable intramedullary nails (ESIN) have shown limitations, including implant migration, irritation, and inadequate rotational stability. This study evaluated the functional outcomes of a newly designed titanium retrograde intramedullary screw nail in the management of displaced midshaft clavicle fractures. Methods  A prospective study was conducted between July 2023 and July 2025, including 24 adult patients (17 males, 7 females; mean age 35.5 years) with Allman Type 1 displaced midshaft clavicle fractures. Fixation was performed using a titanium intramedullary screw nail inserted via a lateral (retrograde) entry under fluoroscopic guidance. Postoperatively, patients were immobilized in a sling for four weeks and subsequently underwent progressive physiotherapy. Evaluations were conducted at 3, 6, and 12 months postoperatively using clinical, radiological, and functional assessments. Functional outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Operative parameters and complications were also recorded. Results  The most common mechanism of injury was a road traffic accident (62.5%). The mean operative time was 45.4 minutes, with an average blood loss of 80.8 mL and an incision length of 13.9 mm. The mean hospital stay was 4.9 days. All fractures achieved union, with one case of delayed union in an elderly osteoporotic patient following nail backout. No infections, implant breakage, or neurovascular complications were observed. The mean DASH score improved from 73.5 preoperatively to 18.8 at 12 months (p < 0.001). Nineteen patients (79.2%) had excellent results and five (20.8%) had fair results. Conclusion  Retrograde intramedullary fixation using a titanium screw nail provides a safe, stable, and minimally invasive method for managing displaced midshaft clavicle fractures. It ensures reliable union, minimal soft-tissue complications, excellent cosmetic outcomes, and early functional recovery. Larger randomized studies are recommended to confirm these encouraging results.