Displaced Midclavicular Fractures In Adults – Which Is Better? Titaniun Elastic Nail Or 1/3rd Tubular Plate

Abstract

Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications there is an increasing trend for operative management. Plating and intramedullary nailing are the most popular surgical options Functional results after both the techniques proved to be superior compared with conservative treatment of DMCF in some recently reported prospective randomized studies. The aim of this study was to compare the clinical result ,functional outcome along with complications rate in minimally invasive antegrade TEN for the treatment of DMCF with that of 1/3rd tubular plating anteriorly. Prospective study was conducted between 2009 and 2016 in which 66 patients (49males and 17 females) with ota type b DMCFs underwent surgical fixation with antegrade TENs and 1/3rd tubular plate. They were randomized in two groups-one with TENS & other with plate fixation with 1/3rd tubular plate. Evaluation done by constant-murley shoulder outcome and dash scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. During analysis we have 34 pts in TENS group & 32 pts in plate group. There was no significant difference in union time, CONSTANT & DASH score. Lesser operating time, less blood loss, easier implant removal & minimal complication with no any case of deep infection seen in TENS group but shortening[>0.5 cm ]was noted in few cases. In plate group there were no major complications, only minor complications of superficial infection, deep infection, hypertrophied scarring without pain, limited shoulder motion with no case of shortening.There is no significant difference regarding union [clinical and radiological] and stability .However TENS is preferable for treating simple displaced fracture of DMCFs in view of lesser morbidity, better cosmetic result, easier implant removal. Fixation with plate seems to be little more stable & its the implant of choice in comminuted fracture