Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures

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Fractures of the clavicle account for 5% of all fractures, and 80% of these fractures are located in the middle third of this S-shaped bone. The incidence of surgical treatment for completely displaced midshaft clavicle fractures (DMCF) is rising owing to poor results reported after nonoperative treatment for this specific subset of patients in recent years.

Intramedullary fixation has emerged as a promising alternative to traditional open reduction and internal plate fixation. Advantages of this minimally invasive treatment option include maintaining the fracture hematoma and keeping the periosteum intact, which positively in consequences bone formation and improves cosmetics owing to the small incisions used. Different techniques and examples of intramedullary fixation devices have been reported and include the Hagie, Knowles and Rockwood pins and titanium elastic nails (TEN).

A spectrum of possible postoperative complications, including pin migration, implant failure, deep and supercial infections, refractures and mal or nonunions has been reported. In the current literature, however, the scientific level of evidence for reported complications from intramedullary fixation of DMCF and the quality of the studies reporting them varies. The aim of this systematic review was to answer the following questions:

1. What is the incidence of major and minor complications associated with intramedullary fixation of acute DMCF?

2. What interventions are available for resolving major or minor complications?

3. What is the value of reported complications in terms of the scientific level of evidence and the quality at which they are presented?