Fuglesang HFS et al. – This prospective, randomized controlled trial compared the functional outcomes of plate fixation and elastic stable intramedullary nailing (ESIN) of completely displaced midshaft fractures of the clavicle in the active adult population. Plate fixation demonstrated faster recovery period in comminuted fractures than ESIN. However, ESIN was preferred in midshaft fractures without comminution owing to shorter operative time and lower rates of infection and implant failure when using ≥2.5 mm or wider nails.

Methods

• A total of 123 patients were randomized to either plate fixation or ESIN.
• The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year with radiographs.
• The Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Constant Score were used to assess clinical outcomes.

Results

• During the first 6 months, plate fixation was associated with faster functional recovery than ESIN without much difference reported after 1 year.
• Mean duration of surgery was significantly shorter for ESIN compared with plate fixation (53.4 minutes vs 69.7 minutes, respectively).
• Due to increasing fracture comminution and open reduction, ESIN demonstrated slow recovery.