A Novel Technique for Midshaft Clavicle Fracture With Ipsilateral Acromioclavicular Dislocation: Titanium Elastic...

Midshaft clavicle fracture (MSCF) combined with ipsilateral acromioclavicular joint dislocations (ACJD) are rare injuries with no consensus on optimal management. This study evaluated a novel technique using a titanium elastic nail (TEN) for MSCF fixation combined with coracoclavicular (CC) ligament reconstruction and acromioclavicular (AC) joint capsule repair for ACJD stabilization.

This retrospective study included 7 patients with MSCF and ipsilateral ACJD who were treated between November 2017 and February 2024. Surgical procedures involved TEN fixation for the MSCF and CC ligament reconstruction with No. 5 Ethibond sutures, augmented with AC joint capsule suturing using No. 2 Ethibond sutures. Clinical assessments included the Constant-Murley score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), range of motion, radiographs, and complications.

Mean follow-up was 24.9 months. All fractures healed at a mean of 10.9 weeks. The mean CMS was 95.9 points (range, 92-100 points), the mean DASH was 5.0 points (range, 2-9 points), and the mean VAS was 0.4 points (range, 0-2 points). The mean active forward flexion, abduction, external rotation, and internal rotation (level) were 175°, 169°, 56°, and T9, respectively. One patient required nail removal for persistent skin irritation. No major complications occurred, including nonunion, implant failure, AC joint arthritis, or recurrent dislocation.

The simple, combined technique of TEN fixation with CC ligament and AC joint capsule reconstruction provided reliable stability and satisfactory short-term radiographic and functional outcomes for MSCF with ipsilateral ACJD, representing a viable, minimally invasive alternative.