Abstract
Introduction:
Displaced and shortened clavicle shaft fractures can be treated operatively by intra- or extramedullary fixation. The aim of the study was to compare the effectiveness of these two treatment modalities.
Methods:
Forty seven patients with acute displaced and shortened clavicle shaft fractures were randomly assigned to either an intramedullary locked fixation group or an anatomically contoured locked plating group. All patients were operated by the same surgeon and had identical post-operative treatment regimes. The effectiveness of both treatment regimens were assessed based on; incision length, operative time and union rate. Disabilities of the Arm, Shoulder and Hand Score (DASH) and Constant Shoulder Score were assessed one year post-operatively.
Results:
Twenty-five patients were included in the plating group and twenty-two in the intramedullary fixation group. No differences between the two groups were found for age, gender, fracture comminution and/or displacement.
Incision size was significantly (p<0.0001) smaller in the nailing group (38±9 mm) than in the plating group (118±19 mm). In line with this the operating time was also shorter in the nailing group than in the plating groups (43±8 min and 60±19 min, respectively (p=0.0029)).
One year postoperatively a 100% union rate was achieved in both groups.
Lower DASH scores (2±5 vs 16±18 (p=0.0071)) and higher Constant Shoulder scores (96±6 vs. 90 ± 18 (p=0.0122)), were found in the nailing group.
Conclusion:
Both anatomically contoured locked plating and locked intramedullary fixation resulted in successful treatment of displaced and shortened clavicle shaft fractures. Intramedullary fixation however was associated with shorter operating times and smaller incision sizes. In addition, better DASH and Constant Shoulder scores were found in the nailing group one year post operatively.
Based on these finding and the absence of prominent subcutaneous hardware necessitating removal of the nail, the intramedullary device is a good alternative to treat displaced clavicle shaft fractures.
