A comparative study between plating versus titanium elastic nail system in mid-shaft clavicle fracture management
Keywords:Clavicle, Randomized trial, Constant and Murley score, Fracture healing
Background: Clavicle fracture is one of most common bony injuries. Despite of high frequency, choice of proper treatment is still a challenge. So a comparative randomized study was planned to compare Plating verses TENS for clavicle fractures management.
Methods: Study was conducted in Department of Orthopedics, M.K.C.G Medical College, Berhampur from November 2015 to October 2017.Patients aged from 20-55 years with closed displaced were included in study. Patients were randomized in two groups- One group (25 pateints) treated with TENS and second group (25) with plate. Outcome assessed by pain VAS score, Constant & Murley score, DASH score, cosmetic result, radiological fracture healing time.
Results: Mean fracture union time in TENS group was 11.4±2.12 weeks and in plate group 13.4±3.46 weeks (difference was significant p=0.016). Mean pain VAS score in TENS group was 2.56±0.91 and in plating group 3.12±0.8 (p=0.023). Tens group were cosmetically more satisfied (mean score 4.48±0.7) than plate group (mean score 3.8±1.0, p=0.009). Mean DASH and Constant Shoulder Score in TENS group were 1.87±3.4, 9.36±7.04 and plate group 4.8±9.0 and 15.08±9.4 respectively. Both were significant (p=0.039, p=0.000).
Conclusions: Our study found that patients treated with TENS showed excellent outcome in 84% cases while 60% in plating group for displaces mid-shaft clavicle fracture. Patients in TENS group better in terms of Constant & Murley score and DASH score than treated with plate.
Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop. 1994;3:127-32.
Robinson C M. Fractures of the clavicle in the adult. J Bone Joint Surg Br. 1998;80:476-84.
Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop. 1968;58:29-42.
Neer CS. Nonunion of the clavicle. JAMA. 1960;17:1006-11.
Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database of Systematic Rev. 2009;2:CD007121.
Neviaser JS. The treatment of fractures of the clavicle. Surg Clin North Am. 1963;43:1555-63.
Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with 9 to 10 years follow-up. J Shoulder Elbow Surg 2004;13:479-86.
Allman FL. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. 1967;49:774-84.
McKee MD. Optimal treatment of displaced midshaft fractures of the clavicle. Philidelphia, Saunders. 2009;1:126-32.
Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997;43:778-83.
Poigenfurst J, Reiler T, Fischer W. Plating of fresh clavicular fractures,Experience with 60 operations. Unfallchirurgie. 1988;14:26-37.
Saha P, Datta P, Ayan S, Garg AK, Bandyopadhyay U, Kundu S. A comparative study-Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures. Indian J Orthop. 2014;48(6):587–93.
McKee MD, Wild LM, Schemitsch EH. Midshaft malunion of the clavicle.Surgical technique. J Bone Joint Surg Am. 2004;86:37-44.