Comparison between locked intramedullary nailing and anatomical locking plating in the treatment of displaced clavicular midshaft fractures

Objective: The aim of this study was to compare the results of expandable flexible locked intramedullary nailing and anatomical locking plating in clavicular midshaft fractures. Methods: Thirty-three patients (21 male, 12 female) who had displaced fractures and at least 2-cm shortening fixed with expandable flexible locked intramedullary nailing and 38 patients (24 male, 14 female) who underwent anatomical locking plating were recruited. Duration of surgery, incision size, duration of hospital stay, union time, and early and late complications were compared between the groups. Functional results were compared with Constant scoring system. Results: Mean duration of surgery was 32.4 +/- 9.1 minutes (range: 20-42 minutes) in the nailing group and 54.1 +/- 11.9 minutes (range: 42-70 minutes) in the plating group. The incision was 4.1 +/- 0.9 cm (range: 3-5 cm) in the nailing group and 9.5 +/- 1.7 cm (range: 7-12 cm) in the plating group. Mean union time was 14.8 weeks (range: 10-24 weeks) in the nailing group and 21.3 weeks (range; 12-33 weeks) in the plating group. Mean duration of hospital stay was 3.6 +/- 1.1 days (range: 2-4 days) in the plating group, whereas it was 2.3 +/- 0.8 days (range: 1-3 days) in the nailing group. In the plating group, an average of 2.7-mm (range: 0-7 mm) shortening was determined in the clavicles that underwent surgery as compared to the intact clavicles, whereas shortening was 2.3 mm (range: 0-6 mm) in the nailing group. Conclusion: Expandable flexible locked intramedullary nailing can provide more successful outcomes than plating in displaced clavicular midshaft fractures, due to advantages such as shorter union time, lower complication rate, and better cosmetic outcomes.