الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Undisplaced midclavicular fractures are generally managed conservatively. Imminent perforation of the skin, impending or existing neurovascular compromise and the floating shoulder represent absolute indications for operative treatment. Gross displacement of fracture fragments, as well as non-unions, are seen as relative indications for surgical fixation. Plate osteosynthesis is the standard operative treatment, but higher complication rates have been described with this technique.(4) The aim of this work was to study the results of treatment of displaced fractures of the elddim third of the clavicle using percutaneous elastic intramedullary sllin. The study included 20 patients suffering from displaced fractures of the middle third of the clavicle presented to Tanta university hospital. The mean age was 26.40 ± 8.91 years (16 – 53 years). Seventeen patients were males (85%), while three patients were females (15%). Thirteen patients had right dominant side affection (65%), while seven patients had left non-dominant side affection (35%). The mechanism of injury was road traffic accident in twelve patients (60%), falling down in five patients (25%) and direct trauma in three patients (15%). According to Robinson classification 16 cases (80%) were type 2b1 (Simple fracture or single butterfly), 3 cases (15%) were type 2b2 (Comminuted or segmental) and one case (5%) type 2a2 (Angulated) . The minimum time lapse before surgery was one day, the maximum was ten days and the mean was 4.60 ± 2.93 days. Three patients (15%) had associated medical conditions. Open reduction was done in 6 cases (30%) out of 20 cases after failed closed reduction of fracture. Time of union in the studied patients ranged from 8 weeks to 12 weeks with a mean 10.0 ± 1.33 weeks with an exception of one case which presented with hypertrophic nonunion. All fractures were fixed with elastic intramedullary nails. All patients were followed up for a period of six month and assessed both radiologically and clinically and scored according to a modified Constant and Murly shoulder score. The final Constant score was 95.70 ± 13.55. Excellent results in fourteen patients (70%), good in four patients (20%), fair in one patient (5%), and poor in one patient (5%). Pain was moderate in one patient (5%),while 19 patients (95%) reported absence of pain. Time of union ranged from 8 weeks to 12 weeks with a mean 10.0 ± 1.33 weeks with an exception of one case which, presented with hypertrophic non-union There was statistically significant relationship between the final score and the patients’ age and associated medical conditions. Complications encountered were infection in one patient (5%), medial skin irritation in two patients (10%), dorsolateral migration in two patients (10%) and hypertrophic non-union in one patient (5%). For infection Intravenous antibiotic was given in compination with metronidazole orally with daily dressing until subsided after about 1 week. For medial skin irritation one patient had to remove the nail while the other resolved within 2 weeks of medical treatment. The two patients with dorsolateral migration were followed up clinically and radiologically until removal of the nail. Lastly, the nail was removed in the non-union case and fracture was fixef by plate and screws.