Surgical Management of Middle Third Clavicle Fracture In Adults by Cannulated Lag Screw

INTRODUCTION; Clavicle fracture is a common traumatic injury around shoulder girdle due to its subcutaneous position. It is caused by either low- energy or high- energy impact. Fracture of the clavicle accounts for approximately 5 to 10 % of all fractures and upto 44 % of injuries to the shoulder girdle. About 80 % of these fractures are in the middle third of the bone and less often in the lateral third ( 15 %) and medial third ( 8 %). AIMS AND OBJECTIVES; To study the role of open reduction and internal fixation in clavicular fractures by single Lag Screw Fixation as surgical procedures over middle 1/3 fracture clavicle, clinically evaluate the results, discuss merits and demerits of surgical procedures, and finally draw conclusions of overall study. METHODOLOGY; The present study was carried out from July2012 to April 2014 at Department of Orthopedics, Career Institute Of Medical Sciences& Hospital, Lucknow. During this period 28 patients of clavicular fractures at middle third region, Type2 B1and B2 were treated surgically by using Cannulated Lag Screw. Adult male and female patients above 18 years who require surgical intervention for displaced and comminution fracture. those with Lateral third and medial third fracture were excluded from present procedure. RESULTS AND OBSERVATIONS; we had 28 cases of middle third clavicle fracture which were fixed by single cannulated Cancellous Lag screw. Postoperatively patient were given only arm sling and from next day they were encouraged swing exercises. The functional outcome is assessed by Constant and Murley score. In this study most patient had excellent functional range in less than 8 weeks. For 8 patients with comminuted fracture, immobilization in Arm sling was preferred more than 8 weeks with gentle mobilization exercises. clavicle fracture fixed with cannulated screw Lag fixation had fairly excellent functional outcome in term of recovery time and cost effective with fairly least complication. CONCLUSION; Clavicle fractures are usually treated conservatively but there are specific indications for which operative treatment is needed like comminuted, displaced middle third clavicle fractures and displaced lateral third clavicle fracture. In this study primary open reduction and internal fixation with Cannulated screws of fresh middle third clavicle fractures provides a more rigid fixation and does not require immobilization for longer periods. In this study, Dynamic compression was achieved by Lag effect provided by single cannulated Cancellous screw is strong and it does not gives excessive prominence through the skin as usually it is prominent when Plate is used. For displaced, comminuted middle third clavicle fracture Cannulated screws fixation and early mobilization gave excellent results. This method of fixation is easier to perform, cost effective, least chance of complications with good functional recovery.