Fig. 1

The principle of the open retrograde TEN fixation technique. a Top view of a right shoulder shows that the medial fragment is held away from the fracture by bone forceps, and drilling is aimed obliquely at its anterior cortex. b The common diameters of the titanium elastic nails that are suitable for clavicle fixation are, from top to bottom, 2, 2.5, and 3 mm. c Insertion of the nail through the reamed canal until it is out of the anterior cortex. The nail is withdrawn from its back end until the curved tip is lying flush to the fracture surface. d The fracture is then reduced and the nail is pushed inside the medullary canal of the lateral fragment