Comparison of plates versus intramedullary nails for fixation of displaced midshaft clavicular fractures.
BACKGROUND
We compare the use of plate and screws versus intramedullary nails in the operative management of patients with displaced midclavicular fractures.


METHODS
Between March 2006 and June 2007, we performed a retrospective comparison of a demographically balanced sample of 110 patients (aged 16-65 years) who had received either plates or nails for completely displaced midshaft clavicular fractures.


RESULTS
We selected 59 plate-fixed and 51 nail-fixed patients. There was no significant difference between the groups with respect to age, gender, height, dominant arm, fracture angulation, fracture shortening, total fracture displacement, or mechanism of injury. Outcomes were significantly higher in the plate group compared with the nail group for the length of hospital stay (4.6 days ± 2.1 days vs. 5.9 days ± 2.6 days, p = 0.006), operative blood loss (67.5 mL ± 36.2 mL vs. 127.9 mL ± 48.8 mL, p < 0.0001), and size of surgical wound (11.9 cm ± 4.4 cm vs. 22.3 cm ± 4.5 cm, p < 0.0001). There was no significant difference in operative time, time to union, restoration of mobility (forward flexion, abduction, external rotation, and internal rotation), number of nonunions, number of malunions, infection, need for hardware removal, early mechanical failure, time to return to work, and Constant Shoulder and Disabilities of the Arm, Shoulder, and Hand functional scores.


CONCLUSIONS
Our results demonstrate no significant differences in functional outcome and nonunion rates between nails and plates fixation for displaced midshaft clavicular fractures.
Liu
Hsin-Hua
HH
Department of Orthopaedic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China. bonesimon0314@yahoo.com.tw
Chang
Chih-Hung
CH
Chia
Wei-Tso
WT
Chen
Chi-Hui
CH
Tarng
Yi-Wen
YW
Wong
Chi-Yin
CY
D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D016009:Chi-Square Distribution; D002968:Clavicle / Q000293:injuries*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome