Nonoperative treatment of the dislocated midshaft clavicle fracture often results into a painfull nonunion and unsatisfactory functional results. Two of the most common surgical approaches include fixation using plate and screws, and intramedullary fixation using nails. The functional results following these treatments are equal, but the rate and consequenses of the complications seem to be variate. In this study we compare the rate of complications following plating versus intramedullary nailing in the operative management of displaced midshaft clavicular fractures. We performed a retrospective analysis of 73 patiënts treated with either intramedullary nailing (n=38) or plate fixation (n=35) in the period between Januari 2000 and May 2010 at the Deventer Hospital or the Medisch Spectrum Twente. There was no significant difference in the number of complications between the two groups. Implant failure occurred significantly more often in the plating group compared with the nailing group (5 patients versus 0 patients, p=0.02). There was no significant difference in demographic data, time to consolidation, hospital stay and Disability of the Arm, Shoulder and Hand score (DASH) between both groups. The patients treated with intramedullary nailing were significantly more satisfied with respect to the functional result (p=0.000) and cosmetic aspect (p=0.000) of the shoulder.
There is no significant difference in the number of complications following intramedullairy nailing or plate fixation in the management of displaced midshaft clavicle fractures. The patients treated with intramedullary nailing were afterwards more satisfied with the final result.
