Displaced mid-shaft clavicular fractures treated surgically by intramedullary nailing: a clinico-radiological and functional outcome evaluation

Background: The traditional conservative treatment of clavicular fractures has shown higher incidences of malunion, non-union, cosmetic deformities and patient dissatisfaction. Intramedullary nailing with Titanium Elastic Nail (TEN) is a promising mode of treatment for displaced midclavicular fractures, which may be an alternative to plate fixation. The aim of this study was to evaluate the functional results in patients with displaced mid-shaft clavicle fracture managed by closed/open reduction and internal fixation using an intramedullary nail.
Materials and Methods: This was a prospective study conducted at a Tertiary care Private Hospital in Kolkata, between July 2019 to January 2021 on patients who underwent intramedullary fixation using TEN for post-traumatic displaced mid-shaft clavicle fracture. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months and 9 months. The patients were evaluated for radiological union and Constant Murley score was used to assess their functional outcome.
Results: In a total of 45 patients, 37 (82.2%) patients showed Excellent and 6 (13.3%) patients had Good results whereas 2 (4.5%) patient demonstrated Poor surgical result at the final follow-up. 88.9% patients did not have any complication. All the patients achieved clinical and radiological union at a mean of 3.34 months. By the end of 9 months, the average Constant Murley score for 45 patients was 92.00 ± 10.48.
Conclusion: Operative treatment with intramedullary nail is a safe, simple and minimally invasive surgical technique having high success rate, quick recovery after surgery, lower rate of complications, faster return to daily activities, excellent aesthetic and comparable functional results as it engenders faster osseous healing and better restoration of clavicle length.