**5. Clinical results**

Xie et al. [31] performed a systematic review of eight overlapping meta-analyses comparing the results of plate versus intra-medullary fixation of displaced midshaft clavicular fractures. While the functional or non-union outcomes did not differ between the two treatment groups, they did document a higher reintervention and refracture rate after implant removal of plate implants.

We reported on 114 of our own cases, with a 2.6% non-union rate [32]. The reoperation rate was also low (1.7%).

#### **Figure 8.**

*Measurement of length of intramedullary fragments both medial and lateral to determine length of intramedullary device.*

#### **Figure 9.**

*Final reduction of fracture over intramedullary pin, the intramedullary device can then be inserted from the lateral percutaneous incision medially across the reduced fracture.*

#### **Figure 10.**

*Care taken to harvest reamings, from the intramedullary drills, yields abundant bone graft to be placed as primary bone graft to promote fracture healing.*

*Intramedullary Fixation of Midshaft Clavicle Fractures DOI: http://dx.doi.org/10.5772/intechopen.112256*

#### **Figure 11.**

*Suturing of periosteal soft tissue attachments of butterfly fragments back into place around reduced fracture.*

#### **Figure 12.**

*Diagrammatic representation of the operative procedure. (a) Hand-drilling the intramedullary canal of the medial fragment. (b) Tapping the intramedullary canal of the medial fragment. (c) The intramedullary canal of the lateral fragment was power drilled. (d) The guide wire is introduced in retrogradely. (e) The posterolateral cortex is drilled out using a step drill. (f) Reinsertion of the guide wire and fracture reduction. (g) Placement of a cannulated Herbert screw at the fracture site. (h) Implantation of harvested bone graft around the fracture site.* 
