Introduction: The clavicle is the most commonly fractured bone, which accounts for 5–10% of all fractures. More than half of these fractures are displaced.
Traditionally clavicle fractures are treated non-operatively. But recent studies show higher rates of nonunion upto 15% and unsatisfactory functional outcomes despite fracture union with conservative management. Operative management of these fractures had better outcomes and a lower rate of nonunion and symptomatic mal union when compared with non-operative treatment.
Commonly either plating or nailing is done for middle third clavicle fractures. It is imperative to know the complications and outcomes with both these procedures.
Aim: The aim of our study is comparative analysis of outcome of Displaced middle third clavicle fractures in patients treated with plate osteosynthesis and intramedullary tens nail.
Materials and Methods: This is a comparative study undertaken in the department of Orthopaedics, Meenakshi Medical College and research institute, Enathur from01/ 09/2017 to 31/08/2018. Within the period of study, 40 patients with displaced middle third clavicle fractures were operated alternatively with Plating and nailing (titanium elastic nail). We had 20 patients who were operated with Locking plate (20 Precontoured Clavicle Plate) and 20 Patients who were operated with nailing (titanium elastic nail). Outcome measures Like Blood loss, operative time, wound size, union rate and union time and Complications like infection, Nonunion, implant irritation and shortening Were compared between the two groups. Functional outcome was based on Quick DASH score.
Results: The mean blood loss in plating group was 89 ml and nailing Group was 35.5ml (p<0.001). The mean operative time in plating was 53.75 and in nailing was 49 (p=0.309). Mean wound size in plating was 10.05 cms and nailing was 4.15 cms (p<0.001).We had 100% union rate in both the groups. The mean time for clinical and radiological union in Plating group was 7.50 weeks and 11.75 weeks whereas in nailing group it was 7 weeks and 12.7 weeks (p=0.172 and p=0.003).We had excellent Outcomes in 13 patients (65%), good outcome in 5 patients (25%) and poor outcome in 2 (10%) patients in the plating group whereas in the nailing group we had 12 patients (60 %) with excellent, 8 (40%) patients with good outcome. No poor outcome in nailing group. We had superficial infection in 2 patients (%) in plating group and no patients in nailing group. Implant irritation occurred in 3 patients (15%) in plating and no patient in nailing groups. Lateral TENS protrusion occurred in 2 patients in nailing group (10%).
Conclusion: We conclude that though nailing has advantage over plating during Surgery and postoperative period, on long term follow up there is no significant functional difference between plating and nailing for displaced Middle third clavicle fractures.