ACOMPARATIVE STUDY OF THE FUNCTIONAL ANDRADIOLOGICAL OUTCOME OF DISPLACED MID SHAFT CLAVICLE FRACTURE MANAGED WITH INTRAMEDULLARY NAILING AND PLATING

Introduction: Clavicle fractures are common injuries in young, energetic people, especially those whoplaysportsinvolvingfrequentviolentcollisionsorhigh-speedfalls(e.g.,football,hockey),butinchildrenandtheelderlytheyareassociatedwithfallsandmakeupabout2.6%ofallfractures(1-3). The most common site of fracture in the clavicle occurs at the middle third and whichaccounts for almost 80% of all clavicle fractures. Withcarefulmanagement,Neerreportedanon-unionrateof0.1%(4),andRoweconfirmedthesefindingsin1968bydemonstratinganon-unionrateof0.8%inpatients.(6)Sincethen,though, other authors have been unable to show that conservative treatment can provideresults as favourable. (7-8). This could be as a result of the early series including childrenand teenagers, whose extraordinary capacity for bone healing may have thrown off theresults,aswellasthefactthatpatient-basedgradingmethodswerenotemployedtorecordtheoutcome in the initial series. Treating conservatively, Hill et al reported a non-union rate of 15% in correlation withinitial shortening greater than 2 cm. 31% of patients who were reviewed in the study ofHillet al werenot satisfied with treatment results.(10) Therefore, even if they mend without complications, displaced midshaft clavicle fracturescan result in significant, long-term morbidity. Thus, there is a trend towards surgicalfixation of clavicle fractures based on the unsatisfactory data obtained from conservativetreatment. For fixation of displaced clavicle fractures good results with high union rates and lowcomplicationrateshavebeenreportedfrommanytechniques. Similartootherlongbones,the clavicle is most effectivelytreated usingintra medullarytechniques. In order to reduce the number of delayed unions., non-union, symptomatic malunion andother complications, elastic stable intra medullary nailing (ESIN) is recommended for allsimpledisplaced midshaft claviclefractures Result: Patients who had their displaced middle-third clavicle fractures surgically fixed had alowerrateofnon-union andsymptomaticmalunion.Giventhatfunctionalratingswereidenticalinbothgroups, it isunclearwhetherthisimpact hasanyclinicalimportance. Overall,bothPFandIMFdemonstrated goodrecoveryrates.RecoverywasfasterinthePF group, with a 55% recovery rate at 6 weeks post procedure according to the DASHscore. Forearlyfunctionalrehabilitation fixationconstructismorerigidandbothobjectiveandsubjectiverecoveryis faster Conclusion: Wecan thereforedraw theconclusion fromourstudythat,when usedfor surgicalfixationof displaced mid-shaft clavicle fractures, pre-contoured plates offered better functionaloutcome and were associated with problems in fewer cases than titanium elastic nails. Upto 6 months, plating had better follow-up results than nailing, but after that, there were noappreciable differences in the prognosis of either operation. Accordingly, we advise usingpre-contoured locking plates for internal fixation of displaced mid shaft clavicle fractures.Low prevalence complications were not found due to the short sample size. For knowingthe prevalence of the more uncommon complications including wound dehiscence,symptomatic malunion, and refracture, a larger sample size will be necessary.Long termfollowsup arerequiredfor furtherresearch.