Midshaft Clavicular Non-Unions Treated with the Herbert Cannulated Bone Screw

Abstract

Purpose. To assess an alternative technique for the treatment of midshaft non-unions of the clavicle. Methods. Five patients with symptomatic non-unions of the clavicle were treated with open reduction and intramedullary fixation by using a Herbert cannulated bone screw. Autogenous bone grafting was applied in one case and decortication in the other 4 cases. Results. Review of the clinical and radiological documentation at a mean time of 13 months (range, 9–26 months) postoperatively shows that union was achieved in all 5 cases. There were no complications related to the operation, and no patient needed removal of the implant for protrusion, loosening, or any other cause. Conclusion. Midshaft non-unions of the clavicle can be treated successfully using the Herbert cannulated bone screw, which avoids the need for a second operation to remove the implant after bone union.

The Role of Bone Decortication in Enhancing the Results of Guided Bone Regeneration: A Literature Review

“…This section addresses the use of decortication to enhance the incorporation of onlay bone grafts and wound healing 16‐20,23‐27,32,33,68‐74 . It does not address the intentional regeneration of bone outside the skeletal structures, which is covered in a subsequent segment of the text.…”

Biomechanical Analysis of Fixation of Middle Third Fractures of the Clavicle

“…[3][4][5][6][7][8][9][10][11] Although various techniques have been advocated for fracture fixation, including plating and intramedullary devices, only a few biomechanical studies provide the treating surgeon with information that may guide the selection of the most appropriate device for surgical repair. [12][13][14][15][16][17][18][19] Plating of middle third clavicular fractures has been supported in clinical studies as a successful and reproducible surgical option. 7,11,[20][21][22][23][24] Although debate has arisen over the ideal location for a plate, 12,19 biomechanical evidence has supported both superior and anterior plate locations depending on the fracture pattern.…”

“…Both clinical and biomechanical studies support the use of intramedullary devices; however, the variability of implant designs has made the selection of the ideal implant difficult. [15][16][17][18] The purpose of this biomechanical study was to address the concept of ideal implant selection for the treatment of middle third clavicular fractures. Using a standardized testing protocol, four implants commonly used in modern orthopaedic practice were tested and compared in a simulated middle third clavicular fracture model.…”

Management of acute displaced midshaft clavicular fractures using Herbert cannulated screw: Technique and results in 114 patients

“…Furthermore, Proubasta et al ., successfully used the 4.5mm Herbert cannulated screw in the treatment of five clavicular non-unions. [18] The current review of 114 midshaft clavicular fractures, also demonstrates that the cannulated HS provides adequate stability of the fracture site against considerable tension, bending, and torsional forces; to allow for early postoperative activities and proper healing course.…”

“…[31617] An ideal intramedullary device needs to be strong enough to hold the fractured fragments in a stable manner, and as well as being biocompatible, it should be technically simple for use. [18] The large fragment cannulated HS seems to offer these advantages and is well suited in size for the management of clavicle fractures.…”