2. • A DEBATABLE FRACTURE
• ALL WILL HAVE DIFFERENT EXPERIENCES
• ALL WILL HAVE DIFFERENT OPINIONS
• MOST OF US ARE IN FAVOUR OF TREATING IT
CONSERVATIVELY
Neerav Modi, 8511010070
3. CASE SELECTION
WE CAN OPERATE ALL DISPLACED AND
COMMUNITED CLAVICLE FRACTURES EXCEPT
LATERAL 3RD FRACTURE
WE CAN NOT OPERATE CLAVICLE WITH A VERY
NARROW CANAL
Neerav Modi, 8511010070
4. BENEFITS
• MINIMALLY INVASIVE
• COSMETIC- small incision
• RESONABALY EXCELLENT ALIGNMENT
• EXCELLENT OUT COME
Neerav Modi, 8511010070
5. DRAWBACKS
• IMPLANT IMPINGEMENT
• WE CAN BREAK CLAVICLE WHILE
NAGOCIATING NAIL
• SOMETIMES DELAYED UNION
• IMPLANT REMOVAL IS MUST
Neerav Modi, 8511010070
6. PREPARATIONS
• ALWAYS KEEP C-ARM ON AFFECTED SIDE
• ALWAYS CHECK FOR REDUCTION BEFORE
DRAPPING
• Surgeon will operate from opposite side
• CHOICE OF IMPLANT is “ TAN NAIL”, we can
use K-wire or Rush nail
• ALWAYS KEEP SET OF PLATES READY
• ALWAYS KEEP SS WIRE SET READY
• Keep threaded K- wire/pin for manipulation
Neerav Modi, 8511010070
7. • INCISION- 1 CM, VERTICAL AND MEDIAL OVER
MEDIAL END OF CLAVICLE.
BLUNT DISSECTION TO FEEL MEDIAL END
Neerav Modi, 8511010070
SURGICAL TECHNIQUE
8. • ENTRY- WITH 2 MM K WIRE FROM MEDIAL END AND
NAGOTIATE WIRE IN AS POSSIBLE.
DILATE THE ENTRY WITH 2.5MM AND 3 MM WIRE
Neerav , 8511010070
9. • NAGOCIATION OF TAN NAIL IN ENTRY
• GO SLOWLY WITH FEELING OF BONE AND CANAL UPTO
FR SITE
• REDUCTION OF FRACTURE AND NAGOCIATE NAIL IN
DISTAL FRAGEMENT
• GO AS MUCH AS POSSIBLE DISTALLY
• TAKE CARE WHILE GOING DISTALLY AS NAIL MAY PIERCE
LATERAL END
• IF POSSBLE PUT ONE MORE NAIL
Neerav Modi, 8511010070
10. Neerav Modi, 8511010070
• AFTER CONFIRMATION AND SATISFACTION ABOUT
REDUCTION AND NAIL PLACEMENT,…
‘DO REMEMBER TO WITHDRAW NAIL UPTO 1 CM,
BEND IT, CUT IT AND RE-INSERT IT BY GIVING
COUNTER PRESSURE TO CLOSE THE FR GAP’.
• CLOSURE OF WOUND
• SHOULDER ARM POUCH WITH RIB BELT
• SUBSEQUENT FOLLOW UPS AND MOBILISATION
14. 28,F OPERATED MTH BACK WITH SEVERE
COMMUNITION & NARROW CANAL , MOBILISED SINCE
ONE MTH, ALL MOVEMENTS PRESENT
2 MTH POST OP
Neerav Modi, 8511010070
B/O SMALL CANAL FURHTER INSERTION OF NAIL WAS NOT POSSIBLE,
2 MTH F/U SHOWS GOOD MOVEMENTS AND UNION