Management of Comminuted Midshaft Clavicle Fractures with Interfragmentary Screws, Non-Invasive Screw Fixation Knot Technique and Plating in 83 Patients.

Introduction: Midshaft clavicle fractures are common, with comminuted variants posing a higher risk of non-union, often necessitating surgical intervention. Anatomical repair is critical due to the clavicle's sole osseous connection between the shoulder and trunk, impacting functional outcomes. Case Series: This retrospective study evaluated 83 patients (74 males, nine females, aged 18-65 years) surgically treated for midshaft clavicle fractures (2010-2023). Dominant-side fractures accounted for 87% of cases. Severe comminution was managed using 2.7 mm cortical interfragmentary screws and the NISE knot technique with plating. Follow-up spanned 18 months, assessing clinical and radiological outcomes. Patients regained near-complete shoulder motion within 3 weeks. Complications included visible deformity (n = 4), keloid formation (n = 3), scar hypoesthesia (n = 5), and one refracture with plate failure. No non-unions occurred, though two cases exhibited delayed union. Radiological and functional recovery was achieved in 97.6% of cases, with minimal long-term sequelae. Conclusion: Surgical fixation of 3- or 4-part comminuted midshaft clavicle fractures using plate and screws demonstrates high union rates, rapid functional recovery, and low complication rates. This approach is recommended for complex fractures, as non-operative management risks non-union, malunion, and functional deficits.