Mid Shaft Clavicle Fractures- Plate vs Titanium Elastic Nail System

Abstract

Abstract It was believed that “all clavicle fractures heal well” is no longer valid. Recent trend is towards operative management, consists of Pre-contoured plate or Titanium Elastic Nail System(TENS) application. Plate fixation remains the mainstay of treatment but Titanium Elastic Nail System application has gained attention in recent years. This study highlights the comparison between two most common modalities available for treatment of mid-shaft clavicle fractures. Objectives:Compare the functional outcome using Neer’s scoring system, radiological outcome and secondary outcomes between two treatment groups. Methods:Patients satisfying inclusion criteria were included in our study and randomized into Group A-operated with plate fixation and Group B-operated with TENS. Routine postoperative protocol and physiotherapy followed. Regular follow up carried out and assessed as per protocol. Results: We had 15 patients in each group by end of our study. There was no significant difference between the two groups in terms of demographics, time to surgery, fracture types. Duration of hospital stay, mean fracture union time were significantly shorter and cosmetically more satisfied in TENS group. Operative time, length of incision, peri-operative blood loss was significantly higher in plate group and length of clavicle better restored. Functional outcome was excellent with no significant difference between two groups. Conclusion:Both methods return the patients to their pre-injury functional levels without significant complications with excellent functional outcome. Titanium Elastic Nail System application has a shorter operative time, lesser duration of hospital stay, lower infection rate and better cosmetic outcome suggesting this is the preferred method with no comminution whereas plate fixation is superior in comminuted fractures.