A comparative study of displaced midshaft clavicle fracture managed by precontoured locking compression plates and titanium elastic nails

Abstract

Background: Results of conservatively managed mid-shaft clavicle fractures are not as good as previously thought. This has lead to increasing interest in primary fixation of these fractures. There are two main techniques of internal fixation, namely, plate fixation and intra-medullary nail fixation. We have evaluated pre-contoured locking compression plates and titanium elastic nails for fixation of midshaft clavicle fractures and compared their results Material and Methods: Between July 1 st 2015 and June 30 th 2017 42 cases of unilateral displaced midshaft clavicular fracture were studied. 23 were managed by open reduction internal fixation with precontoured locking compression plates and 19 were managed by closed or open reduction and internal fixation by Titanium Elastic nails. Patients were followed up monthly for 4 months and at 6 months and 9 months. Final results were computed at end of 6 months. Functional outcome was compared using Constant Score. Other complications like non-union, delayed union, infection, implant failure, hardware prominence, refracture and wound dehiscence were also studied. Results: There was significant difference in constant score of two group with plating group performing better. Nail impingement was major concern after intra-medullary nailing. Union time was slightly better in nailing group. Conclusion: Pre-contoured locking compression plates gave better functional outcome and were associated with complications in fewer cases as compared to titanium elastic nails when used for surgical fixation of displaced mid-shaft clavicle fractures.

Comparison of plate fixation vs. intramedullary fixation for the management of mid‑shaft clavicle fractures: A systematic review and meta‑analysis of randomised controlled trials

“…The sample size varied from 15-63 patients per group. The type of plate fixation used was different across studies: Titanium elastic nail was the choice of intramedullary fixation in 7 studies ( 15 , 28-30 , 32 , 33 , 35 ), while 2 utilized a Sonoma CRx Collarbone pin (Sonoma) ( 14 , 31 ) and 1 trial reported on the use of the Rookwood pin ( 34 ). Post-operative data were obtained after a follow-up of 12 months in the majority of studies, while 1 study reported follow-up data at 6 months ( 32 ).…”

“…A total of 5 studies evaluated shoulder function outcomes using Constant-Murley scores as well as DASH scores ( 14 , 15 , 30 , 33 , 35 ). Shoulder function was assessed exclusively by Constant-Murley scoring in 4 studies ( 28 , 29 , 32 , 34 ) and only by DASH scoring in 1 study ( 31 ). Data were not presented as the mean and SD by 2 studies ( 15 , 32 ) and attempts to contact the authors were unsuccessful; hence, they were not included in the meta-analysis ( Table SI ).…”

“…Only three studies were pre-registered with clinical trial registries ( 15 , 30 , 35 ). Based on the scoring criteria, all studies were rated as being of ‘medium quality’, except one ( 32 ), which was rated as being of ‘low quality’. Removal of the ‘low-quality’ study in the sensitivity analysis did not affect the results for any variable.…”

“…While a large number of reviews were already published on this subject, the present study has the strength of an updated literature search, allowing for inclusion of 4 more RCTs ( 14 , 15 , 32 , 33 ) compared with a previous meta-analysis ( 18 ). Furthermore, to circumvent the intrinsic bias associated with cross-sectional studies and avoid the higher risk of methodological bias of quasi-randomized trials from influencing the present results, these study types were excluded from the present review.…”

“…In addition, the influence of varied operator experience and surgical techniques on outcomes cannot be completely excluded. As another limitation, the sample size of the majority of studies was small with only two studies ( 15 , 32 ) including >50 patients per group. Finally, as previously discussed, the number of patients with comminuted fractures in the included studies is not known.…”