Can Intramedullary Nails Be Used In Clavicle Reduction Osteotomies?

Q: Dr. Eppley, Can you do the intramedullary instead of plates and screws for fixation of clavicle reduction osteotomies? (shoulder reduction)

A:In regards to the intramedullary nail my research indicates that, while it works for fractures that have an established length, if one is trying to shorten or lengthen the clavicles it may not be very stable at length retention. Knowing how hard it is physically to drive the shoulders in to get the outer half of the clavicle to meet the inner half when a bone segment is removed, it would be suspect that it could maintain keeping the two segments together. It would work if the two bone ends freely laid together without much tension (as in a normal fracture) but the shoulder girdle is both heavy and powerful. As a result,  a single intramedullary may look good on the operative stable but its true effectiveness is what happens between the two bone ends after surgery when continuous tension is applied to it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon