title: Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial.
abstract: BACKGROUND
  Over the past decades, the operative treatment of displaced midshaft clavicular fractures has increased. The aim of this study was to compare short and midterm results of open reduction and plate fixation with those of intramedullary nailing for displaced midshaft clavicular fractures.
  
  
  METHODS
  A multicenter, randomized controlled trial was performed in four different hospitals. The study included 120 patients, eighteen to sixty-five years of age, treated with either open reduction and plate fixation (n = 58) or intramedullary nailing (n = 62). Preoperative and postoperative shoulder function scores and complications were documented until one year postoperatively. Significance was set at p < 0.05.
  
  
  RESULTS
  No significant differences in the Disabilities of the Arm, Shoulder and Hand (DASH) or Constant-Murley score (3.0 and 96.0 points for the plate group and 5.6 and 95.5 points for the nailing group) were noted between the two surgical interventions at six months postoperatively. Until six months after the surgery, the plate-fixation group experienced less disability than the nailing group as indicated by the area under the curve of the DASH scores for this time period (p = 0.02). The mean numbers of complications per patient, irrespective of their severity, were similar between the plate-fixation (0.67) and nailing (0.74) groups (p = 0.65).
  
  
  CONCLUSIONS
  The patients in the plate-fixation group recovered faster than the patients in the intramedullary nailing group, but the groups had similar results at six months postoperatively and the time of final follow-up. The rate of complications requiring revision surgery was low. Implant-related complications occurred frequently and could often be treated by implant removal.
authors: Department of Surgery, Diakonessenhuis Utrecht, P.O. Box 80250, 3508 TG Utrecht, the Netherlands. E-mail address for E.J.M.M. Verleisdonk: ejverlei@diakhuis.nl.
authors: Olivier A
authors: OA
authors: van der Meijden
authors: Department of Surgery, Diakonessenhuis Utrecht, P.O. Box 80250, 3508 TG Utrecht, the Netherlands. E-mail address for E.J.M.M. Verleisdonk: ejverlei@diakhuis.nl.
authors: R Marijn
authors: RM
authors: Houwert
authors: Department of Surgery, Diakonessenhuis Utrecht, P.O. Box 80250, 3508 TG Utrecht, the Netherlands. E-mail address for E.J.M.M. Verleisdonk: ejverlei@diakhuis.nl.
authors: Martijn
authors: M
authors: Hulsmans
authors: Department of Surgery, Diakonessenhuis Utrecht, P.O. Box 80250, 3508 TG Utrecht, the Netherlands. E-mail address for E.J.M.M. Verleisdonk: ejverlei@diakhuis.nl.
authors: Frans-Jasper G
authors: FJ
authors: Wijdicks
authors: Clinical Research Unit, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
authors: Marcel G W
authors: MG
authors: Dijkgraaf
authors: Department of Surgery, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, the Netherlands.
authors: Sven A G
authors: SA
authors: Meylaerts
authors: Department of Surgery, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands.
authors: Eric R
authors: ER
authors: Hammacher
authors: Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
authors: Michiel H J
authors: MH
authors: Verhofstad
authors: Department of Surgery, Diakonessenhuis Utrecht, P.O. Box 80250, 3508 TG Utrecht, the Netherlands. E-mail address for E.J.M.M. Verleisdonk: ejverlei@diakhuis.nl.
authors: Egbert J M M
authors: EJ
authors: Verleisdonk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D012783:Shoulder Dislocation / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult