Comparison of Plates versus Intramedullary Nails for Fixation of Displaced Midshaft Clavicular Fractures

Background: We compare the use of plate and screws versus intramedullary nails in the operative management of patients with displaced midclavicular fractures. Methods: Between March 2006 and June 2007, we performed a retrospective comparison of a demographically balanced sample of 110 patients (aged 16-65 years) who had received either plates or nails for completely displaced midshaft clavicular fractures. Results: We selected 59 plate-fixed and 51 nail-fixed patients. There was no significant difference between the groups with respect to age, gender, height, dominant arm, fracture angulation, fracture shortening, total fracture displacement, or mechanism of injury. Outcomes were significantly higher in the plate group compared with the nail group for the length of hospital stay (4.6 days +/- 2.1 days vs. 5.9 days +/- 2.6 days, p = 0.006), operative blood loss (67.5 mL +/- 36.2 mL vs. 127.9 mL +/- 48.8 mL, p < 0.0001), and size of surgical wound (11.9 cm +/- 4.4 cm vs. 22.3 cm +/- 4.5 cm, p < 0.0001). There was no significant difference in operative time, time to union, restoration of mobility (forward flexion, abduction, external rotation, and internal rotation), number of nonunions, number of malunions, infection, need for hardware removal, early mechanical failure, time to return to work, and Constant Shoulder and Disabilities of the Arm, Shoulder, and Hand functional scores. Conclusion: Our results demonstrate no significant differences in functional outcome and nonunion rates between nails and plates fixation for displaced midshaft clavicular fractures.