Anil Yadav Rangi, Y Naga Akhil, Apurva Jonnalagadda, Sanibhoni Gayathri

Abstract

Background: Displaced midshaft clavicle fractures account for approximately 70–80% of all clavicle fractures and constitute one of the most common upper extremity injuries encountered in orthopaedic trauma practice. Whilst conservative management has historically prevailed, growing evidence supports operative fixation in displaced fractures to restore clavicular length, improve functional recovery, and reduce rates of symptomatic malunion and non-union. Both open reduction and internal fixation with anatomical plating (ORIF-plate) and closed or open reduction with titanium elastic intramedullary nailing (TENS) are established surgical options; however, direct prospective comparison of their functional and radiological outcomes remains an area of active investigation.

Objectives: To prospectively compare the functional outcomes, time to radiological union, complication profiles, and return-to-activity rates between anatomical plate fixation and titanium elastic intramedullary nailing for displaced midshaft clavicle fractures.

Methods: A prospective comparative cohort study of 30 patients with displaced midshaft clavicle fractures was conducted between September 2022 and January 2024. Fifteen patients were allocated to ORIF with anatomical plating (Group A) and 15 to titanium elastic nailing, 2.0–2.5 mm diameter (Group B). Outcomes were assessed at six weeks, twelve weeks, and final follow-up using Constant–Murley Shoulder Score and DASH (Disabilities of the Arm, Shoulder, and Hand) score. Radiological union, time to early mobilisation, and complications were recorded for each group.

Results: Both groups achieved 100% union in anatomical position with no non-union or malunion. Radiological union by twelve weeks was achieved in 14 of 15 nailing patients (93.3%) compared with 11 of 15 plating patients (73.3%) (p = 0.001). Mean time to early active mobilisation was significantly shorter in Group B (14 days vs. 28 days; p < 0.001). Functional outcomes were superior in the TENS group at twelve weeks (p < 0.05). Complications were qualitatively distinct between groups: plating was associated with wound infection (2 cases), shoulder stiffness (3 cases), and hypertrophic scarring (3 cases); TENS was associated with nail migration (2 cases) and lateral skin irritation at the nail tip (2 cases), with zero infections.

Conclusion: Titanium elastic intramedullary nailing with a nail diameter of 2.0–2.5 mm is a superior surgical option to anatomical plate fixation for displaced midshaft clavicle fractures in terms of early mobilisation, time to radiological union, and functional recovery, with a favourable complication profile. Plating retains distinct advantages for comminuted fractures and established non-union where intramedullary purchase is insufficient. A risk-stratified, individualised approach to implant selection is advocated.