[Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction].

OBJECTIVE: Closed reduction and intramedullary nailing is common in diaphyseal clavicle fractures. The aim of this report is to demonstrate a surgical method with minimally invasive percutaneous reduction in cases where closed reduction fails. The procedure is associated with good cosmetic results. INDICATIONS: Percutaneous reduction using two reduction forceps enables intramedullary nailing without an open procedure. CONTRAINDICATIONS: Open, multifragmented or non-dislocated fractures, oblique fractures due to postoperative dislocation or shortening risk, fracture having potential to become compound fractures, neurovascular complications, pseudoarthroses. SURGICAL TECHNIQUE: The patient is in beach-chair position. After an incision, the nail is entered from medial, two reduction forceps are mounted percutaneously at the lateral and medial fragment. After reduction the nail is pushed forward into the lateral fragment. Thereby, the fracture hematoma is not disturbed for the most part. POSTOPERATIVE MANAGEMENT: Early functional rehabilitation with maximal abduction and anteversion of 90° for 6 weeks.
RESULTS: Anatomic reduction can be achieved with mild cosmetic impairment.