Abstract: Background: Fracture of clavicle account for 2-6% of all adult fractures and approximately 80% of the site involved in adult patients is mid-shaft clavicle. Despite of high frequency, substantial controversies exist in surgeons regarding the optimal fixation pattern for treating these injuries and further research is necessitated. So a comparative randomised study was planned to compare Plating versus TENS for management of mid-shaft fracture clavicle.
Methods: Study was conducted in Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur from January 2018 to June 2019. Patients aged from 18-55 years with closed displaced fracture were included in the study. Patients were then randomized into two groups- Group A treated with Plate and Group B treated with TENS. Outcome was assessed by DASH score, cosmetic result, clinical and radiological fracture healing time.
Results: A total of 40 patients were in the study, out of which 22 patients were treated with precontoured plate and 18 patients were treated with TENS. The mean blood loss in plating group was 97.27 ml and nailing group was 62.22 ml (p<0.05). The mean operative time in plating was 77.27 and in nailing was 61.67 (p=0.005). Mean wound size in plating was 7.22 cms and nailing was 4.55 cms (p<0.05). We had 100% union rate in both the groups. The mean time for clinical and radiological union in plating group was 7.9 weeks and 14 weeks whereas in nailing group it was 7.55 weeks and 13 weeks (p=0.40 and p=0.070). We had excellent outcomes in 14 patients (63.63%), good outcome in 6 patients (27.27%) and poor outcome in 2 patients (9.09%) in the plating group whereas in the nailing group we had 12 patients (66.66%) with excellent, 6 patients (33.33%) with good outcome. No poor outcome in nailing group. We had superficial infection in 4 patients (18.18%) in plating group and 2 patients (11.11%) in nailing group. Implant irritation occurred in 4 patients (18.18%) in plating and 2 patients (11.11%) in nailing groups. Shortening was 4.5 mm in plating and 4.8 mm in nailing group.
Conclusions: 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.
