[Failures of clavicular intramedullary wire fixation and their causes]

The fixation of fractures of the clavicle by intramedullary Kirschner wires is a semirigid method. External fixation of the arm after operation is, therefore, necessary. 25 out of 38 fresh fractures in our series healed in ideal position of the fragments. Another eight fragments healed under angulation of 10 degrees to 35 degrees. Five patients developed pseudarthrosis, three of whom had multiple fragmentation. Only two of a total of eight multiple fractures healed in good position. The causes for negative results are multiple fragmentation or technically insufficient fixation--mainly perforation of the corticalis of the medial fragment by the wire and therefore improper position of fragments and K-wires or too short intramedullary run of the wire in the medial fragment. Wires of less than 2.0 mm in diameter are not strong enough to withstand the bending forces. The intramedullary wire fixation gives adequate results in transverse or short oblique fractures of the middle third of the clavicle if good reposition is obtained and if the thickest possible wire or, better, two wires are introduced. In all other cases and especially in multiple fragmentation higher stability has to be achieved by plate fixation.