Type A and B midshaft clavicular fractures can be successfully treated with plate or titanium elastic nail (TEN) fixation; however, type C fractures should be treated with plate fixation, a new study finds.
Plate Fixation or Titanium Elastic Nailing, That Is the Question
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Secondary#midshaftclavicularfracture#platefixation#titaniumelasticnailfixation
In the study, “Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications,” published online on December 1, 2020 in the Journal of Orthopaedic Surgery, the researchers compared plate fixation for midshaft clavicular fractures to titanium elastic nail (TEN) fixation to understand differences in outcomes and related complications.
The research team collected data from 97 patients with midshaft clavicular fracture who either underwent plate (48 patients) or TEN (49 patients) fixation. The team then divided the two groups retrospectively into three subgroups by fracture type using the AO Foundation/Orthopaedic Trauma Association classification: simple fracture (type A), wedge fracture (type B), and multi-fragmentary (type C).
The researchers then analyzed outcome measures such as bone union rate, related complications, functional scores and patient satisfaction score based on fracture classification.
Overall, both groups had high union rates (p = 0.495) and functional scores (p > 0.05). However Visual Analog Scale scores for satisfaction were better in TEN than plate fixation (p < 0.001).
In type A and B subgroups, functional scores were similar in both fixation groups (p > 0.05). Patients with a type C fracture who underwent TEN fixation, however had worse Visual Analog Scale score and disabilities of the arm, shoulder, and hand score at 2 and 6 weeks postoperatively (p < 0.05).
In the type C fracture group, clavicle shortening and skin irritation tended to occur more often with TEN fixation than plate fixation (p < 0.05).
The authors wrote, “Patient satisfaction of TEN fixture was higher than that of plate fixation, but TEN fixation had a higher incidence of early postoperative pain and migration in type C fractures. Therefore, type A and B fractures can be successfully treated with plate or TEN fixation, but type C fractures should be treated with plate fixation.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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