Diaphyseal fractures of the clavicle in adults, comparative study of LCP(Locking Compression Plate) versus intramedullary nailing with TENS (Titanium Elastic Nailing System)

Abstract

Background: Fractures of clavicle are one of the most common fractures in traumatic injury around shoulder girdle as the bone is sub cutaneous throughout. Open reduction and internal fixation with locking compression plate have become the mainstay of treatment for most of the midshaft fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the clavicle. Intramedullary nailing with TENS(Titanium elastic nailing system) has also proved to be effective with better cosmetic effect, faster union, and less operating time. Objectives: To determine the functional outcome using constant scoring system following both plating and nailing technique and also to observe the various complications arising with both procedures.Methodology:This study is a prospective study of 80 cases that were admitted and operated in the dept. of orthopedics attached to R. L. Jalappa hospital from June 2016 - December 2018. 40 patients included in the LCP were operated from June 2016 to October 2017 and the rest 40 in TENS group were operated from October 2017 to December 2018. Skeletally mature patients with age group > 18 years, closed displaced mid shaft fracture of clavicle, polytrauma patients were included. Patients with open fractures, pathological fractures, non-union, ipsilateral limb pathology and with ipsilateral neuro-vascular injury were excluded. The functional outcome was assessed using CONSTANT scoring system during follow-up after LCP and intramedullary nailing for clavicle fractures at 6weeks, 3months and 6months.Student t test and chi square test was used as the test of significance. P value <0.05 was considered as statistically significant. Results: Length of incision, operation time and duration of hospital stay were less for the TENS group. There was no significant difference between the two groups regarding radiological outcome but Constant Shoulder scores were significantly higher (p<0.0001) in the TENS group than the LCP group by the end of 6 month follow-up.Infection and revision surgery rates were also higher in the plate group.
Conclusion:We can conclude from our study that Titanium elastic intramedullary nailing TENS is a safe, minimally invasive surgical technique with a lower complication rate, faster return to daily activities, excellent cosmetic and comparable functional results, and can be used as a better alternative for surgical fixation of displaced midshaft clavicular fractures in place of current trend of locking compression plating.