Abstract
Introduction: Traditionally, mid-shaft clavicular fractures were treated non-operatively; however, they have been associated with higher non-union rates and poor functional outcomes in certain types of fractures. We aimed to objectively compare the surgical outcomes in patients with mid-shaft clavicular fracture treated either with nailing or plating and assess their functional outcomes over a follow up period of one year.
 Methodology: Our prospective sample was chosen from a pool of patients visiting casualty of our Hospital for fracture clavicle between March 2015 and March 2017. Patients either underwent open reduction and plate fixation with a 3.5 mm superior clavicular plate or a 2.0 mm to 3.5 mm titanium nail. Intraoperative parameters and postoperative functional outcomes over a period of 12 months were compared between the two patient groups. 
 Results: During the study period 65 patients with clavicular fracture were operated in our department, 35 patients with dynamic compression plating and rest intramedullary fixation and nailing. Patients undergoing nailing had a significantly lesser operative time, incision length, blood loss and hospital stay as compared to plating (p value < 0.001). Mean Constant Murley score throughout the follow up period was higher in the group of patients undergoing plating, though the difference was not significant at any follow up point. Nailing was associated with more frequent implant migration and irritation of skin and there was need of significantly more number of intraoperative image intensifier shoots, resulting in higher radiation exposure, as compared to plating. Nailing and plating resulted in mean shortening of clavicle length by 0.5 cm (range 0.4 to 2.1 cm) and 0.2 cm (range 0.2 to 1.8 cm) respectively.
 Conclusions: We found no difference in the functional outcome and nonunion rates between nails and plates fixation for displaced midshaft clavicular fractures but nailing was associated with higher rates of complications.
 Keywords: Clavicle fracture, midshaft, intramedullary fixation, plate fixation, osteosynthesis, trauma
Highlights
Mid-shaft clavicular fractures were treated non-operatively; they have been associated with higher non-union rates and poor functional outcomes in certain types of fractures
We found no difference in the functional outcome and nonunion rates between nails and plates fixation for displaced midshaft clavicular fractures but nailing was associated with higher rates of complications
Mid-shaft clavicular fractures were treated non-operatively; they have been associated with higher non-union rates and poor functional outcomes in certain types of fractures.ii A recently published meta-analysis of randomized clinical trials revealed that patients treated non-operatively had higher risk of non-union and symptomatic malunion than those who received operative treatment.iii there has been a trend towards operative treatment in patients with displaced clavicular fractures
Summary
Mid-shaft clavicular fractures were treated non-operatively; they have been associated with higher non-union rates and poor functional outcomes in certain types of fractures. Two of the most common surgical approaches include open reduction and internal fixation with pre-contoured plate fixation, and intramedullary nailing using a titanium endomedullary nail Though, both techniques demonstrate adequate stability biomechanically, plate fixation results in lesser displacement when higher loads are applied, which may be a beneficial factor during the rehabilitative protocol.iv this difference in functional outcome is not appreciable clinically. Major concern is with hardware displacement and tissue irritation associated with the use of intramedullary nailing in clavicle midshaft fractures.v We aimed to objectively compare the surgical outcomes in patients with mid-shaft clavicular fracture treated either with nailing or plating and assess their functional outcomes over a follow up period of one year
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