| Clavicle Fractures - Pin v Plate |
Treating Clavicle Fractures (Broken Collar Bone)
More and more patients have been contacting me about the new method of treating clavicle fractures using a ‘pin’ rather than the traditional ‘plate and screws’ so I thought I ought to write about why I think it is a better method.
The first thing to say is that this type of pin (the Rockwood Pin) is nothing like the old-style, thin, smooth pins which have been used in the past with pretty disastrous results. Their main problem was that they could migrate out of the bone and have ended up in the middleof the chest where they could cause a lot of damage!
The Rockwood Pin has a wide, coarse screw-thread which is twisted into the medullarycanal of the clavicle (the central ‘hole’) and it isn’t going anywhere!
So, if you are discussing options with your surgeon and mention the ‘pinning’ operation make sure that the surgeon knows you are talking about the Rockwood Pin and not the old-style smooth pin.
One of the main reasons I prefer the pin is that it can be inserted through a much smaller incision than is needed for the plate. Wounds in the front of the shoulder have a tendency to stretch out as they heal and can end up quite wide and unsightly. This is definitley an issue worth considering especially for ladies who tend to have their clavicles on display more than men do. In the acute situation ie. an operation within a week or two, the scar will probably only need to be about 4-5 cms long. If I am using the pin for an un-united fracture ie. many months after the break, then the scar does need to be longer to get access so I can remove scar tissue.
There is also a second incision with the pin but this is only 2cms long and is sited on the back of the shoulder so is not really an issue.
Detractors of the pin will say that you have to have two operations - one to put it in and one to take it out. They are right. But the majority of people treated with a plate elect to have it removed as well even though there is no absolute requirement for that. The reason is that the plate can be quite obtrusive as it sits just under the skin with no padding over it. So it can rub and be uncomfortable when things are carried on the shoulder. And, as it has to be taken out via the same incision it went in through, you have another biggish scar thatneeds to heal.
Also, when the screws have been taken out, they are a site of potential weakness until they fill in with bone. So you have to limit your physical activities for a month.
The pin is taken out through the small posterior scar and this can be done under local anaesthetic so avoiding the risks of a general anaesthetic. The small wound heals rapidly and you don’t have to limit your activities.
For a broken bone to heal the two ends have to be aligned and then compressed together.The pin does this brilliantly because it ‘kebabs’ the two pieces such that they are perfectly lined up and by tightening the nuts, the ends are extremely well compressed. These mechanisms maximise the chance of the bone healing.
Many of the UKs Shoulder Surgeons now recommend the Rockwood Pin to treat clavicle fractures and I have had great results since I started using it. However it isn’t used universally and there will be many hospitals where it is not an option. The traditional ‘plate and screws’ remains a perfectly acceptable alternative.