Functional Outcomes of Minimally Invasive Titanium Elastic Nailing for Displaced Midshaft Clavicle Fractures: A Prospective Study.

BACKGROUND

Displaced midshaft clavicle fractures account for the majority of all clavicular injuries. Titanium elastic nailing system (TENS) offers a minimally invasive alternative to plate fixation. The primary objective was to assess the efficacy and safety of minimally invasive TENS by evaluating functional, clinical, and radiological outcomes, including union and complication rates, in displaced midshaft clavicle fractures.

METHODS

This prospective study included 30 patients (25 male and five female patients; mean age 38.06 years) with displaced midshaft clavicle fractures treated with TENS between December 2019 and August 2021. Fractures were classified using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification as 18 Type 15-B1 and 12 Type 15-B2. Follow-up occurred at one, three, and six months. Outcomes were assessed using the Constant-Murley score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analog Scale (VAS).

RESULTS

Closed reduction succeeded in 25 (83.3%) patients. Mean surgical time was 31.67 minutes. Clinical union occurred at 6.7 weeks and radiological union at 8.43 weeks. At six months, the mean Constant score was 91.00 ± 4.51, with 26 (86.7%) patients having excellent results; the mean DASH score was 12.30 ± 2.93, and the mean VAS score was 3.53 ± 1.17. Hardware removal was required in nine (30.0%) patients, supraclavicular paresthesia occurred in five (16.7%) patients, and minimal shortening occurred in seven (23.3%) patients. One patient developed a nonunion. No deep infections or hardware breakage developed.

CONCLUSIONS

Minimally invasive titanium elastic nailing appears to be a useful treatment option for displaced midshaft clavicle fractures, with favorable short-term functional and radiological outcomes in this prospective single-arm study. The procedure was associated with timely union and acceptable complication rates, although hardware-related problems such as nail migration and implant removal were not uncommon.