A comparative study of anatomical plate fixation versus intramedullary nailing of middle-third clavicle fractures in Al-ameen medical college hospital

Background: Clavicle fractures constitute 5% of adult fractures. About 80% involve the midshaft, with more than 70% displaced. Many plate and intramedullary fixation systems have been used. However, the best fixation method is still debated. Surgery includes ORIF with Anatomical Plate and CRIF with TENS. Each technique has its own advantages and disadvantages. Methods: 40 patients with displaced middle-third clavicle fractures were prospectively randomly assigned to two groups, Group-A (plating group) and Group-B (nailing group), with an equal number of 20 patients in each. The outcomes were evaluated based on Union-time, Complications, Visual-Analog-Scale for pain. The assessment of shoulder function was conducted using the DASH score. Results: 9 (45%) of Group A patients achieved union in 6-7 months and 11 (55%) in 8 months, mean union time being 7.5 months. 4 (20%) had implant prominence, 3 (15%) had hypertrophic scar, 1 (5%) had plate-end protrusion post-union, and 2 (10%) had surgical site infection managed by intravenous antibiotics. In group B, 16 (80%) patients achieved union by 6-7 months and 4 (20%) by 8 months, mean union-time being 7.1 months. 3 (15%) patients had nail-end prominence, 3 (15%) had nail-end irritation by 4 months, one (5%) had nail-end protrusion by 6 months, and one (5%) had medial migration by 8 months. No surgical site infection occurred. Conclusion: Plating provides firm fixation, greater rotational stability for displaced middle-third clavicular fractures. Complications with plating like scarring, implant prominence, irritation are significantly lesser in nailing. Both fixations provide good functional outcome.