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 highenergy clavicular fractures with comminution and displacement is increasing, for which reduction
and maintenance with braces and bandages are not only uncomfortable with need for frequentmonitoring of loosening and complications, but also insufficient resulting in unacceptablemalunions 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 ofthe study was to evaluate the functional outcome, rate and time for union, possible complicationswith 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 threegovernment 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 assessedin 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 thepoint 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 isa safe and simple procedure with good functional outcome and recommended as a method of
treatment.
Key words: Clavicle fracture, Open reduction, Internal fixation, K-wire fixation