Functional Outcome of Intramedullary Screw Nail Fixation versus Conservative Management in Displaced Midshaft Clavicle Fractures: A Randomized Controlled Trial

Background: Non-operative treatment is the treatment of choice for midshaft clavicle fractures. There may arise some problems like impairment of ROM of shoulder, disfigurement of the local area with bump at the site for the fracture which may be cosmetically distressing to patient and nonunion can occur when grossly displaced fractures are treated non-operatively. Patients with displaced clavicle fractures can be managed with either ORIF with plating or CRIF with intramedullary nailing. Problem with intramedullary nailing of clavicle was implant migration which has been solved with newer implant i.e SCREW NAIL. Article includes the comparison of clinical outcomes of patients with displaced clavicle fracture managed conservatively and surgically i.e with intramedullary screw nail. Material and Methods: 30 patients suffering from midshaft clavicle fracture were included in the study. 15 patients were managed conservatively with figure of 8 clavicular brace and 15 were managed surgically with CRIF with intramedullary screw nail fixation. 30 subjects will be equally allocated into two groups using a computer generated random allocation plan determined by www.graphpad.com software. Outcomes were measured using the UCLS scoring system of the clavicle. Follow-up was taken on 1st month, 3rd months, 6th month post-surgery. Results: A statistically significant difference(p value =0.0001) was found in the UCLS shoulder score between the operative and conservative group at 1 month post-operative follow-up probably due to the early mobilisation in the operative group. The average UCLS score in the operative group was found to be 24.27 ± 3.13 whereas in the conservative group it was found to be 16.4 ± 1.18. A statistically non-significant (p value=0.0524) result was found at 3 months follow-up between the conservative and the operative group. The average UCLS score for the operative groups were found to be 27.64 ± 2.59 whereas average UCLS score for the conservative group was 25.47 ± 3.14. It was found that there was statistically significant (p value=0.0003) difference in the UCLS score between the operative group and the conservative group at the end of 6 months. Most of the patients in the conservative age group were not able to achieve the highest functional scores compared to the operative group. The average UCLS score in the operative group was found to be 31.54 ± 1.39.whereas the average UCLS score for the conservative group was 29.27 ± 1.49. Conclusion: Open reduction internal fixation with intramedullary screw nail is a reliable method in management of the displaced fractures of midshaft clavicle with high union rates and better functional outcomes with surgery done by trained person compared to conservative management. There were no reported complications like implant migration with screw nail. The University of California and Los Angeles shoulder score at the end of 6 months were found to be better for the subject who underwent open reduction internal fixation with intramedullary screw nail compared to those managed conservatively. The time of union was found to be less for the subject who underwent ORIF with intramedullary screw nail compared to those managed conservatively.