Year: 2026 | Month: August | Volume: 16 | Issue: 8 | Pages: 55-65
DOI: https://doi.org/10.52403/ijhsr.20260806
Plate Fixation Versus Titanium Elastic Nailing for Displaced Midshaft Clavicle Fractures: A Prospective Study
A Rishidhar1, Rajagopal H P2, Jayant Jain3, Satish Shervegar4, Mahesh G5, Ravi M Daddimani6, H B Shivakumar7
1Postgraduate Student, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
2Professor, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
3Professor, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
4Professor, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
5Professor, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
6Professor, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
7Professor, Department of Orthopaedics,
Sapthagiri Institute of Medical Sciences & Research Centre, Bengaluru, India.
Corresponding Author: Dr. Jayant Jain
ABSTRACT
Background: Displaced midshaft clavicle fractures are increasingly managed surgically because of the higher risk of non-union and functional impairment associated with conservative treatment. Plate fixation and titanium elastic intramedullary nailing (TENS) are commonly employed surgical techniques; however, evidence regarding their comparative functional outcomes remains limited.
Methods: This prospective comparative non-randomized study was conducted at a tertiary care teaching hospital to compare the clinical and functional outcomes of anterosuperior plate fixation and titanium elastic intramedullary nailing (TENS) in adults with displaced midshaft clavicle fractures. Based on a priori sample size estimation, 40 patients were enrolled and prospectively allocated to either the plate fixation group (n=20) or the TENS group (n=20). Patients were followed for six months. Primary outcome measures included time to fracture union and functional outcome assessed using the Constant Shoulder Score. Secondary outcomes included postoperative complications. Data were analysed using the Mann–Whitney U test, independent Student's t-test, repeated-measures ANOVA with Bonferroni post hoc analysis, and Fisher's exact test.
Results: Baseline demographic and injury characteristics were comparable between the two groups. The mean time to fracture union was 10.50 ± 1.47 weeks in the plating group and 10.40 ± 2.01 weeks in the TENS group, with no significant difference (p=0.86). At one month, the TENS group demonstrated significantly higher Constant Shoulder Scores than the plating group (74.1 ± 4.8 vs. 68.4 ± 5.2), with a mean difference of 5.7 points (95% CI: 2.5–8.9; p=0.001) and a large effect size (Cohen's d=1.14). No significant differences were observed at three months (p=0.16) or six months (p=0.17). Repeated-measures ANOVA demonstrated significant improvement in Constant Shoulder Scores over time within both groups (p<0.001). Postoperative complications were infrequent and comparable between groups (Fisher's exact test, p=0.83), with no cases of deep infection or non-union.
Conclusion: Both anterosuperior plate fixation and titanium elastic intramedullary nailing are safe and effective surgical options for displaced midshaft clavicle fractures, achieving comparable fracture union and low complication rates. TENS provides significantly superior early functional recovery, although long-term functional outcomes are similar between the two techniques. The choice of fixation should therefore be individualized according to fracture characteristics, patient factors, and surgeon expertise.
Key words: Clavicle fracture; plate fixation; titanium elastic intramedullary nailing; TENS; Constant Shoulder Score; functional outcome.