Comparative analysis of outcome of displaced middle third clavicle fractures in patients treated with plate osteosynthesis and intramedullary nailing

INTRODUCTION: The clavicle is the most commonly fractured bone, which accounts for 5–10% of all fractures.More than half of these fractures are displaced. Traditionally clavicle fractures are treated non operatively. But recent studies show higher rates of non union upto 15% and unsatisfactory functional outcomes despite fracture union with conservative management. Operative management of these fractures had better outcomes and a lower rate of non union and symptomatic mal union when compared with non operative treatment. Commonly either plating or nailing is done for middle third clavicle fractures. It is imperative to know the complications and outcomes with both these procedures. AIM: The aim of our study is comparative analysis of outcome of displaced middle third clavicle fractures in patients treated with plate osteosynthesis and intramedullary nailing. MATERIALS AND METHODS: This is a prospective study undertaken in the department of orthopaedics, Coimbatore medical college hospital, Coimbatore from May 2011 to October 2013.Within the period of study,20 patients with displaced middle third clavicle fractures were operated alternatively with plating nailing(titanium elastic nail).We had 11 patients who were operated with plating (6-RECONSTRUCTION plate and 5- PRECONTOURED CLAVICLE PLATE) and 9 patients who were operated with nailing(titanium elastic nail).Outcome measures like Blood loss, operative time, wound size, union rate and union time and complications like infection, Non union, implant irritation and shortening were compared between the two groups. Functional outcome was based on Quick DASH score. RESULTS: 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 7 patients (63.63%),good outcome in 3 patients (27.27%) and poor outcome in 1 patient (9.09%) in the plating group whereas in the nailing group we had 6 patients (66.66%) with excellent,3 patients (33.33%) with good outcome. No poor outcome in nailing group. We had superficial infection in 2 patients (18.18%) in plating group and 1 patient (11.11%) in nailing group. Implant irritation occurred in 2 patients (18.18%) in plating and 1 patient (11.11%) in nailing groups. Shortening was 4.5 mm in plating and 4.8 mm in nailing group. CONCLUSION: 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