Plating Versus Titanium Elastic Nailing in Treatment of Midshaft Fracture Clavicle

Introduction: Clavicle fractures are common, representing 44% of shoulder injuries, with 80-85% occurring at midshaft. While undisplaced fractures are managed conservatively, complex displaced fractures often require surgery to prevent malunion or non-union. Titanium elastic nailing (TENS) and plate fixation are established surgical options. This study aimed to compare their clinical outcomes, complication rates, and overall effectiveness for displaced midshaft clavicle fractures.Methods: This randomized controlled prospective trial included 30 adult patients (15 TENS, 15 plate fixation) with midshaft clavicle fractures from Suez Canal University Hospital. Inclusion criteria involved patients aged 16-60 years with specific displacement features. Fractures were classified using the AO/OTA system. Outcome measures included time to union, functional scores, perioperative data (e.g., operative time, blood loss), and various complications.Results: Baseline characteristics were comparable between groups, and open reduction was performed in all patients. The TENS group demonstrated significantly shorter operation time, lower blood loss, and smaller surgical wound size (all p<0.009). TENS also achieved faster fracture union (p=0.001). However, clavicular length shortening was more pronounced in the TENS group (p=0.008). Pain and functional scores were not statistically significant (p>0.05). Overall complication rates were comparable, though specific complications differed; one nonunion occurred in the plate group. Conclusion: TENS and plate fixation effectively treat midshaft clavicular fractures, providing excellent functional outcomes. TENS offered advantages in operative efficiency and union time, while plate fixation resulted in less clavicular shortening and distinct complication patterns.