Functional Recovery Trends in Operated Clavicle Shaft Fractures: What 40 Cases Reveal About Implant Choice

Abstract

Background: Clavicle shaft fractures, particularly those involving the midshaft, are
commonly encountered in orthopaedic trauma. While surgical intervention has
gained prominence over conservative approaches for displaced fractures, the choice
between plate osteosynthesis and elastic intramedullary nailing remains a matter of
debate.
Objective: To compare the functional outcomes, fracture union time, and
complication rates between patients treated with plate osteosynthesis and those
managed with titanium elastic nailing (TENS) for displaced midshaft clavicle
fractures.
Methods: A prospective observational study was conducted on 40 patients with
Robinson Type 2B1 and 2B2 midshaft clavicle fractures at a tertiary care centre
between January 2023 and December 2024. Twenty patients underwent plate
osteosynthesis, while twenty were treated with TENS nailing. Patients were assessed
postoperatively using the Visual Analogue Scale (VAS) for pain, Disabilities of the
Arm, Shoulder and Hand (DASH) score for functional outcome, and radiological
time to union. Follow-ups were conducted at 1, 3, and 6 months post-surgery.
Results: Both groups were comparable in terms of age, sex, mode of injury, and
laterality. At 6 months, TENS group patients had marginally better VAS and DASH
scores, though not statistically significant (p > 0.05). Mean clinical union times were
8.4 ± 1.3 weeks for plating and 8.3 ± 1.4 weeks for TENS (p = 0.82). The TENS
group experienced fewer complications and better cosmetic satisfaction.
Conclusion: Both plate osteosynthesis and TENS nailing are effective for treating
midshaft clavicle fractures. While functional outcomes are comparable, TENS offers
advantages in cosmesis, reduced invasiveness, and slightly faster recovery, making it
a preferred choice in simple, non-comminuted fractures.