CLAVICLE NAILING BY NEERAV MODI

• 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

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

BENEFITS

• MINIMALLY INVASIVE

• COSMETIC- small incision

• RESONABALY EXCELLENT ALIGNMENT

• EXCELLENT OUT COME

Neerav Modi, 8511010070

DRAWBACKS

• IMPLANT IMPINGEMENT

• WE CAN BREAK CLAVICLE WHILE NAGOCIATING NAIL

• SOMETIMES DELAYED UNION

• IMPLANT REMOVAL IS MUST

Neerav Modi, 8511010070

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

• INCISION- 1 CM, VERTICAL AND MEDIAL OVER MEDIAL END OF CLAVICLE.

BLUNT DISSECTION TO FEEL MEDIAL END

Neerav Modi, 8511010070

SURGICAL TECHNIQUE

• 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

• 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

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

OPERATED C/O 35,M WITH SEGMENTAL FRACTURE

Neerav Modi, 8511010070

RECENTLY OPERATED, 48,M

Neerav Modi, 8511010070

Pre-Op

Post-Op

4 months post op

45,F OPERATED 5 MTHS BACK, IMPLANT REMOVAL DONE

Neerav Modi, 8511010070

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

C-ARM VIDEO

Neerav Modi, 8511010070

Thanks

Neerav Modi, 8511010070