The fact that the clavicle is the most commonly fractured bone in the human body would seem to ensure a level of study sufficient to render treatment formulaic. Indeed, this was largely the case after Neer reported on thousands of clavicle fractures, with nonunion rates of 0.1% for midshaft fractures with nonoperative treatment. That report guided generations of clavicle treatment until questions were posed with regard to the lack of outcomes reported and the heterogeneity of the patients included in the study. Recent large prospective studies have yielded diametrically opposite conclusions with regard to the outcomes of operative and nonoperative treatment.
Andrade-Silva et al. examine the technique aspect of this issue with a well-constructed, prospective, randomized study evaluating the outcomes of two types of clavicle fixation—reconstruction plate fixation and elastic stable intramedullary nailing. Previous studies have shown improved outcomes when comparing elastic stable intramedullary nailing with plating. Andrade-Silva et al. seek to clarify whether this association holds up under continued scrutiny.
The authors report patient outcomes measured with the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores. The improvements in both groups (the group receiving fixation involving elastic stable intramedullary nailing, referred to in the study as the nail group, and the group receiving fixation involving reconstruction plates, referred to in the study as the plate group) were similar and differences were not significant. The mean six-month DASH score was 9.9 points in the plate group and 8.5 points in the nail group (p = 0.329). Similarly, the authors report that fracture union occurred at seventeen weeks in the plate group and sixteen weeks in the nail group (p = 0.352). In the nail group, one case of nonunion occurred that required repeat internal fixation and went on to union.
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