Intramedullary screw fixation for middle-third clavicle fracture: A study of 39 cases

Background: Midshaft clavicle fractures are common and often treated conservatively, but surgical fixation offers superior outcomes in displaced or comminuted cases. Intramedullary screw fixation provides a minimally invasive, cost-effective alternative to plating, especially in low-resource settings. Methods: We conducted a prospective study of 39 patients with displaced midshaft clavicle fractures (Robinson type IIA2 or IIB1) treated with intramedullary screw fixation at Xuyen A Tay Ninh Hospital from February 2023 to September 2024. Screws (4.5–5.5 mm) were selected based on individual clavicle anatomy. Outcomes included radiographic union, Constant-Murley Score, and complications. Results: All patients achieved radiographic union, with a mean healing time of 10.1 ± 2.9 weeks and a follow-up of 12.3 ± 2.5 months. The most common screw was 4.5 mm diameter (74.4 %) and 90 mm length (59 %). At 6 months, 87.2 % had excellent, 7.7 % good, and 5.1 % fair outcomes. Complications included prominent screw heads (10.3 %) and delayed union (5.1 %), managed non-surgically. Mean operative time was 65.8 ± 14.7 min. Conclusion: Intramedullary screw fixation demonstrates a relatively safe and effective method for managing displaced midshaft clavicle fractures, offering practical advantages in low-resource surgical environments.