Functional Outcome of Primary Kirschner Wire Fixation in two Part Mid Clavicular Fractures

Abstract

Introduction: Middle third is the commonest site for clavicular fractures. Incidence of high energy clavicular fractures with comminution and displacement is increasing, for which reduction and maintenance with braces and bandages are not only uncomfortable with need for frequent monitoring of loosening and complications, but also insufficient resulting in unacceptable malunions and nonunions. Intramedullary Kirschner`s wire fixation is a safe and simple procedure, with small incision and little soft tissue dissection. It has good result in terms of patient comfort, union rate, cosmesis, and ease of hardware removal following fracture union. The objective of the study was to evaluate the functional outcome, rate and time for union, possible complications with primary Kwire fixation of the two part middle third clavicular fractures.

Method: It was a prospective observational study, with in a period of one year, in three government hospitals in Kathmandu. 28 cases with displaced 2 part middle third clavicle fracture were included. Intramedullary K-wire fixation (2.5mm) was done and outcome was assessed in terms of time of fracture union, complication rate, DASH scores and compared with similar studies done elsewhere.

Result: 18-50 years old patients, 20 males and 8 females were involved in the study. Fall on the point of shoulder was commonest mechanism of fracture(56%). Mean time of union was 7.6 weeks(6-11 weeks). Superficial wound infection was seen in 4 cases, hematoma in 1. There was no nonunion, malunion, k-wire migration, hardware failure, and neurovascular injury. K-wire was removed after the radiological union of fracture was seen.

Conclusion: Primary intramedullary K wire fixation of middle third two part clavicle fracture is a safe and simple procedure with good functional outcome and recommended as a method of treatment.