Comparison of the functional outcome of intramedullary nailing versus plating in displaced midclavicular fractures

Abstract

AIMS: The aim of this prospective study was to evaluate the effectiveness of intramedullary nailing and fixation by locking plates in displaced midclavicular fracture and to compare the functional outcome of intramedullary nailing versus plating. MATERIALS AND METHODS: This prospective comparative study was conducted at the tertiary center between October 2013 and September 2015 after being approved by the local Ethical Committee. A total of 66 patients ranging between 18 and 60 years of age were included in this study. They were randomized into two groups to be treated either by an intramedullary nail or by locking plate. Clinical and radiological assessments were performed at the 3rd week and 6th week and 3rd, 6th, and 12th month postoperatively. Outcomes and complications were compared to the 1-year follow-up in both groups. RESULTS: There was no significant difference found between two groups with regard to functional outcome after fracture union. Although lesser operative time, lower blood loss, less duration of hospital stay, easier implant removal, and better cosmetic appearance were noted in the nailing group. Constant shoulder scores were significantly higher in plating groups when compared to nailing group for the 1st 12 weeks of follow-up. However, this difference becomes insignificant between the two groups after 6 months of follow-up. Infection and revision surgery rates were more in plating group, but this difference is not significant. CONCLUSIONS: Functional outcome and complications remain same in intramedullary nailing and plating group. However, intramedullary nailing is advantageous concerning faster healing, secure implant removal, and better cosmetically appeared scars.