**3. Risks**

Numerous sensory supraclavicular nerves run over the clavicle, supplying skin over the anterior chest down to the level of the nipple. The area of numbness created by the surgical approach to the clavicle is directly related to the size of the incision. Plating techniques typically require larger incisions than intramedullary approaches, resulting in a higher risk of numbness or dysthaesia.

It has been demonstrated that both the subclavian artery and vein lie very close to the inferior surface of the clavicle bone (12.2 mm and 8.3 mm, respectively) [27, 28] and are at risk of damage if a drill bit is plunged or an excessively long screw is used when plating midshaft clavicle fractures. The brachial plexus is also intimately related to the midshaft of the clavicle (within 8.3 mm). Bain et al. [29] have documented a pseudo aneurysm of the axillary artery after plating of a midshaft clavicular fracture. These findings resulted in the conclusion that an anterior approach is potentially safer than a superior plating approach. The apex of the lung is also just deep to

### **Figure 2.**

*Well reduced clavicle fracture with intra medullary cannulated screw with differential threaded Herbert styled screw threads to aid with fracture stabilization, compression and rotational control.*

the neurovascular structures and may be at risk, with resultant pneumothorax, if damaged.

The preparation of a midshaft clavicle fracture for fixation with an intramedullary screw is done entirely within the plane of the clavicle, protecting the nearby neurovascular structures.
