Outcome of intramedullary elastic nailing and plate fixation of midshaft clavicle fractures: A single-centre retrospective study

Displaced midshaft clavicle fractures (MCFs) are common injuries in orthopaedic trauma. While plate fixation remains the conventional surgical treatment, intramedullary elastic nailing (TEN) has gained popularity as a minimally invasive alternative. Evidence comparing these techniques remains inconclusive. This study aimed to compare clinical outcomes, radiographic union, and complication profiles of TEN versus plate fixation in adult patients with displaced MCFs. A retrospective cohort study was conducted at Sultan Qaboos University Hospital between January 2012 and December 2022. Adult patients (≥18 years) with displaced MCFs treated surgically with either TEN or plate fixation within 14 days of injury were included. Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and visual analogue scale (VAS) for pain. Radiographic time to union and postoperative complications were recorded. Thirty patients met the inclusion criteria (TEN, n = 14; plate, n = 16). The mean time to radiographic union was slightly shorter in the TEN group (10.7 ± 8.2 weeks) compared with the plate group (12.1 ± 6.5 weeks), without reaching statistical significance (p = 0.055). Functional outcomes at final follow-up were comparable between groups, with no significant difference in QuickDASH scores (TEN: 20.3 ± 30.1 vs. plate: 18.4 ± 18.2; p = 0.443). Implant-related complications were significantly more frequent in the TEN group, with all patients requiring implant removal, compared with 18.7% in the plate group (p = 0.002). Rates of nonunion and shoulder stiffness were similar between groups. TEN and plate fixation provide comparable functional outcomes and union rates for displaced midshaft clavicle fractures. However, TEN is associated with a significantly higher rate of implant-related irritation and secondary implant removal. Plate fixation may therefore be preferable when long-term implant retention is desired.