Open AccessA COMPARATIVE STUDY OF SURGICAL AND FUNCTIONAL OUTCOMES IN PATIENTS TREATED WITH INTRAMEDULLARY NAILING AND PLATING FOR MID-SHAFT CLAVICULAR FRACTURES
Author(s) -
Vidisha Kulkarni,
Siddharth S. Vakil,
Supreet Bajwa,
S Gurucharan,
Jayant T. Bhosale,
Saksham Tripathi
Publication year - 2020
Publication title -
international journal of medical and biomedical studies
Language(s) - English
Resource type - Journals
eISSN - 2589-8698
pISSN - 2589-868X
DOI - 10.32553/ijmbs.v4i7.1275
Subject(s) - medicine , intramedullary rod , surgery , clavicle , internal fixation , fixation (population genetics) , implant , population , environmental health
Introduction: Traditionally, mid-shaft clavicular fractures were treated non-operatively; however, they have been associated with higher non-union rates and poor functional outcomes in certain types of fractures. We aimed to objectively compare the surgical outcomes in patients with mid-shaft clavicular fracture treated either with nailing or plating and assess their functional outcomes over a follow up period of one year.
Methodology: Our prospective sample was chosen from a pool of patients visiting casualty of our Hospital for fracture clavicle between March 2015 and March 2017. Patients either underwent open reduction and plate fixation with a 3.5 mm superior clavicular plate or a 2.0 mm to 3.5 mm titanium nail. Intraoperative parameters and postoperative functional outcomes over a period of 12 months were compared between the two patient groups.
Results: During the study period 65 patients with clavicular fracture were operated in our department, 35 patients with dynamic compression plating and rest intramedullary fixation and nailing. Patients undergoing nailing had a significantly lesser operative time, incision length, blood loss and hospital stay as compared to plating (p value < 0.001). Mean Constant Murley score throughout the follow up period was higher in the group of patients undergoing plating, though the difference was not significant at any follow up point. Nailing was associated with more frequent implant migration and irritation of skin and there was need of significantly more number of intraoperative image intensifier shoots, resulting in higher radiation exposure, as compared to plating. Nailing and plating resulted in mean shortening of clavicle length by 0.5 cm (range 0.4 to 2.1 cm) and 0.2 cm (range 0.2 to 1.8 cm) respectively.
Conclusions: We found no difference in the functional outcome and nonunion rates between nails and plates fixation for displaced midshaft clavicular fractures but nailing was associated with higher rates of complications.
Keywords: Clavicle fracture, midshaft, intramedullary fixation, plate fixation, osteosynthesis, trauma