Abstract
Introduction: Mid-shaft clavicular fractures that are displaced and shortened are often treated surgically. The standard technique in the past has been to use plate fixation. However, in the last five years intramedullary fixation has been popularised. To our knowledge no recent study has compared the outcomes of intramedullary pinning and plating of displaced mid-shaft clavicular fractures.
Method: We retrospectively evaluated 40 patients with mid-shaft clavicular fractures. Twenty patients had plate fixation and twenty patients had intramedullary fixation for exactly the same fracture pattern. Each patient filled out a standardised questionnaire particular to clavicular fractures and was assessed using the Shoulder Score Index of the American Shoulder and Elbow Surgeons and the Constant Score. A physical examination was performed and individual radiographs were assessed to determine the state of union.
Results: All fractures that were treated with intramedullary pin fixation went on to union within two to three months. There was one nonunion in the plate fixation group requiring revision surgery. The results revealed no significant difference in the functional outcome scores. There were however fewer complications, less scar related paraesthesia, shorter stay in hospital, and earlier mobilization in the group who underwent intramedullary pinning.
Conclusions: Our results suggested that both techniques of intramedullary pinning and plating resulted in good long-term functional outcomes for patients with acute mid-shaft clavicular fractures. Intramedullary pinning, however, resulted in fewer short-term complications. From this study the method of fixation for mid-shaft clavicle fractures should be determined by the surgeon’s preference and expertise.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
