Functional Outcome of Operative Titanium Elastic Nailing System Versus Non-Operative Figure-of-Eight Bandage in Displaced Mid-Shaft Clavicle Fractures: A Randomized Controlled Study.

INTRODUCTION

Displaced midshaft clavicle fractures are commonly treated either conservatively using a figure-of-eight bandage or operatively with the Titanium Elastic Nailing System (TENS). However, evidence comparing these modalities remains limited. This study compared the functional and radiological outcomes of TENS with conservative management in adults with displaced midshaft clavicle fractures.

MATERIALS AND

METHODS

This randomized controlled study was conducted over 2 years at the Department of Orthopaedics, Indira Gandhi Medical College and Research Institute, Puducherry. Sixty adults with Allman Group I displaced midshaft clavicle fractures were randomized into TENS (n = 30) and figure-of-eight bandage (n = 30) groups. Functional outcomes were assessed using the Constant-Murley Score and Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 weeks, 3 months, and 6 months. Radiological union, complications, return to activity, and patient satisfaction were also evaluated.

RESULTS

Fifty-eight patients completed follow-up. The TENS group demonstrated significantly better early functional recovery with lower DASH scores at 6 weeks (59.55 ± 3.55 vs. 65.12 ± 4.72; P < 0.001), while Constant-Murley scores were higher but not significantly different. At 6 months, both groups achieved comparable Constant scores (96.48 ± 1.68 vs. 96.46 ± 2.85; P = 0.857) and low DASH scores. Fracture union was achieved in all patients, with slightly earlier radiological union and earlier return to activity (9.6 vs. 10.8 weeks) in the TENS group. Minor implant-related complications occurred following TENS but did not influence the outcome. Patient satisfaction was high in both groups.

CONCLUSION

TENS provides superior early functional recovery, earlier return to daily activities, and high patient satisfaction compared with figure-of-eight bandage treatment, while both treatment modalities achieve excellent fracture union and comparable long-term functional outcomes. The treatment should be individualized according to patient characteristics, fracture pattern, and functional demands.