الفهرس 
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Abstract
Clavicular fractures account for 5% to 10% of all fractures and 35% to 45% of shoulder girdle injuries. Most common mid-shaft fractures account for about 80% of all clavicular fractures, followed by lateral third fractures (12% to 15%) and lastly medial third fractures (5% to 6%).(2)
Undisplaced midclavicular fractures are generally managed conservatively, e.g. with a figure-of-eight-bandage. Imminent perforation of the skin, impending or existing neurovascular compromise and the floating shoulder represent absolute indications for operative treatment. Gross displacement of fracture fragments, as well as non-unions, are seen as relative indications for surgical fixation. Plate osteosynthesis is the standard operative treatment, but higher complication rates have been described with this technique.(4)
To overcome these disadvantages minimally invasive ESIN was established as an alternative to plate fixation.
The aim of this work was to study the results of treatment of displaced fractures of the middle third of the clavicle using percutaneous elastic intramedullary nails. The study included 20 patients suffering from displaced fractures of the middle third of the clavicle presented to El Hadara university hospital.
The mean age was 26.40 ± 8.91 years (16 – 53 years). Seventeen patients were males (85%), while three patients were females (15%). Thirteen patients had right dominant side affection (65%), while seven patients had left non-dominant side affection (35%). The mechanism of injury was road traffic accident in twelve patients (60%), falling down in five patients (25%) and direct trauma in three patients (15%). The minimum time lapse before surgery was one day, the maximum was ten days and the mean was 4.60 ± 2.93 days. Three patients (15%) had associated medical conditions, the first had hypertension, the second had diabetes mellitus and the third was mentally retarded. Open reduction was done in 6 cases (30%) out of 20 cases after failed closed reduction of fracture. Time of union in the studied patients ranged from 8 weeks to 12 weeks with a mean 10.0 ± 1.33 weeks with an exception of one case which presented with hypertrophic non-union.
All fractures were fixed with elastic intramedullary nails. All patients were followed up for a period of six month and assessed both radiologically and clinically and scored according to Constant and Murly shoulder score.
The final Constant score was 95.70 ± 13.55. Excellent results in eighteen patients (90%), adequate in one patient (5%) and poor in one patient (5%). There was statistically significant relationship between the final score and the patients’ age and associated medical conditions.
Complications encountered were medial skin irritation in two patients (10%), dorsolateral migration in two patients (10%) and hypertrophic non-union in one patient (5%).