Clinical Evaluation of the Treatment of Clavicle Fractures: Intramedullary Nail × Plate

Abstract

Objective: Studies confirm the benefit of surgical treatment for fixation of displaced midshaft clavicle fractures. Plate fixation and intramedullary nail are the two most used techniques. Our study seeks to compare these two surgical techniques. Methods: This is a retrospective study, conducted by the evaluation of patients treated for displaced midshaft clavicle fracture with intramedullary nail, and plate and screws. Socioeconomic variables were collected, a visual pain scale questionnaire was applied, the shoulder function was measured using CONSTANT and UCLA scores, and radiography was performed to verify the consolidation and evaluation of the final clavicle shortening. Results: Sixty-five patients were evaluated, 36 (55.4%) of which were subjected to clavicle fixation with plate and screws and 29 (44.6%) with intramedullary nail. The median shortening was 0.1mm for plate and 5.8mm for nail (p = 0.001). The UCLA score shows an average of 35 in the plate group and 35 in the intramedullary group. The median CONSTANT scores were 96.5 for plate and 95 for nail, without significance. In all groups, 13 (20%) complications were registered, 9 fixed with plate and 4 fixed with intramedullary nail. The most common complication was skin erosion with exposure of the synthetic material. Conclusion: The two techniques present satisfactory results for the treatment of displaced midshaft clavicle fractures. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis

“…Concerning superior locking plates, 23 studies were identified. 1 , 2 , 4 , 9 , 10 , 12 , 13 , 17 , 19 , 20 , 24 , 28 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 63 , 66 , 76 The average patient age from all studies was 37.8 years (range 17-79) with mean length of follow-up of 29.3 months. Five studies reported a Constant-Murley Score (CMS) 14 at 6 months, 1 of these studies did not include a standard error.…”

“…Many studies that did report time points did not use the same time points addressed in this review. Finally, several studies used a functional outcome measure that we were not analyzing, 1 , 5 , 12 , 49 , 63 which prevented us from including such studies in the meta-analyses. Despite heterogeneity, the individual study complications and functional outcome scores were pooled.…”