BACKGROUND The midshaft clavicle fractures account for 3 to 5% of all injuries and 70 to 80% of all clavicle fractures in young adults; these fractures are usually related to sports or vehicle accidents, whereas in children and elderly they are usually related to falls. In general, clavicle fractures are treated conservatively and have a good outcome. In 1960, Neer reported a non-union rate of 0.1% with conservative treatment and Rowe corroborated these findings in 1968 and showed a non-union rate of 0.8% in conservatively managed patients. Since then, however, other authors have failed to demonstrate similar good results with conservative treatment. More recently, there has been a trend toward surgical fixation. Surgery has been indicated for completely displaced fractures, potential skin perforation, shortening of clavicle by more than 20 mm, neurovascular injury and floating injury. The gold standard for the surgical treatment has been open reduction and plate fixation through a large incision. Other surgical options include intramedullary pinning with Kirschner wire, Rush pins, Knolwes pin, Steinman pin, Haige pin, ESIN (Elastic Stable Intramedullary Nailing) and external fixation. MATERIALS AND METHODS We analysed the consecutive series of 38 patients who presented to us with clavicle fractures between January 2013 to June 2015 and they were treated with TENS. All the patients were reviewed postoperatively in the clinic at 2, 6, 12 weeks and 6 months or until the fracture had healed clinically and radiologically. The aim of the present study was to evaluate the functional and radiological results of intramedullary fixation of mid-clavicular fractures. RESULTS All the patients achieved clinical and radiological union at a mean of 11.3 weeks (Range, 6-20 weeks). Eleven of the 38 patients had closed nailing while 27 patients (71%) required open reduction of their fracture. There was no statistical difference between the functional scores and the range of movement when the scores were compared at 3, 6 months and the last follow-up. The average Oxford Shoulder Score was 45.6 (range, 37-48). The average Quick DASH score was 6.7 (Range, 0-13.6) at the last follow-up. CONCLUSION Titanium elastic nails are a promising minimally invasive treatment for displaced mid-clavicular fractures, which may be an alternative to plate fixation (ORIF) or even non-operative treatment.
