الفهرس 
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Abstract
Clavicular fractures account for 5% to 10% of all fractures and 35% to 45% of shoulder girdle injuries. Most commonly, mid-shaft fractures account for about 80% of all clavicular fractures, followed by lateral third fractures (12% to 15%) and lastly medial third fractures (5% to 6%). (3)
In fractures of the middle one-third of the clavicle, non-union rates range from 0.1 to 4.8% after non-surgical management. (2)
The aim of this work was to study the results of intramedullary fixation in the treatment of displaced fractures of the middle third of the clavicle by Titanium intramedullary elastic nails. The study included 20 patients suffering from displaced fractures of the middle third of the clavicle presented to Sohag University Hospital.
The mean age was 32.2 ± 11.6 years (15-60). Thirteen patients were males (65%), while seven patients were females (35%). Twelve patients had dominant side affection (60%), while eight patients had non-dominant side affection (40%). The mechanism of injury was road traffic accident in ten patients (50%), falling from a height in five patients (25%), falling down in four patients (20%), and falling of a heavy object in one patient (5%). The minimum time lapse before surgery was one day, the maximum was fifteen days and the mean was 3.9 ± 3.78 days.
All fractures were fixed with an intramedullary elastic nail through an entry point in the anterior cortex of the Clavicle 1 inch medial to the Sternoclavicular joint. Patients were followed up for a period of six months and assessed both radiologically and clinically and scored according to Constant and Murly’s shoulder score.
The final result obtained was excellent in thirteen patients (65%), good in four patients (20%), fair in two patients (10%) and poor in one patient (5%). There was no statistically significant difference between the final outcome and the patients’ age, sex, side affected, time lapse before surgery, and the presence of associated injuries or medical conditions.
Complications encountered were soft tissue irritation by the tip of the elastic nail medially at the entry point in 5 patients (25%) and medial migration of the elastic nail in one patient (5%).
CONCLUSIONS
1- Fixation of non-comminuted mid-shaft Clavicular fractures using an intramedullary elastic nail is an effective method of treatment in selected cases.
2- All of the patients included in the study experienced complete union over the observation period, and the majority had scars that were aesthetically acceptable and had good range of motion and strength. The procedure has low morbidity and good overall results.
3- The procedure requires careful planning and approach particularly when making the entry point medially to avoid injury of related vital organs and structures.
4- Soft tissue irritation at the site of the entry point is a common complaint among treated patients.