Operative Treatment of Adolescent Diaphyseal Clavicle Fracture: Elastic Stable Intramedullary Nail Versus Plate Fixation

Abstract

Background and Objectives: Adolescent diaphyseal clavicle fracture surgery has increased in recent years. However, the optimal operative method remains debated, particularly between elastic stable intramedullary nailing (ESIN) and plate fixation. This study compared postoperative outcomes and complication rates between ESIN and plate fixation for treating diaphyseal clavicle fractures in adolescent patients. Materials and Methods: We conducted a retrospective review of 35 adolescents who underwent surgery for diaphyseal clavicle fractures between 2010 and 2024. Patients were assigned to either the ESIN group (n = 18) or the plate fixation group (n = 17). Postoperative outcomes assessed included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, intraoperative time, time to complete fracture union, and clavicle shortening at 1 year postoperatively. Postoperative complications were also evaluated. Results: Fracture union occurred significantly faster with ESIN than with plate fixation, specifically 3 weeks earlier (11.0 weeks vs. 14.0 weeks; p < 0.001). No significant differences were observed between the groups in QuickDASH scores, intraoperative time, or clavicle shortening at 1 year. The overall postoperative complication rate was 25.7% (9/35), with no statistically significant difference between the ESIN (27.8%) and plate fixation groups (23.5%) (p = 0.774). Refractures occurred exclusively in the plate fixation group (n = 2), while one patient in the ESIN group required early nail removal due to insertion site irritation. Conclusions: ESIN provided functional and radiographic outcomes comparable to plate fixation in adolescents with diaphyseal clavicle fractures, with a 3-week shorter time to union and a less-invasive surgical approach.

Keywords: adolescent; diaphyseal clavicle fracture; elastic stable intramedullary nail; plate fixation.

Figure 1

Clavicle length was measured from the most lateral to the most medial point of the anteroposterior radiograph. The length of the fractured clavicle was compared with that of the uninjured contralateral side for the calculation of clavicle shortening (both white lines).

Figure 2

A 14-year-old male patient underwent intramedullary nail fixation for a diaphyseal clavicle fracture (a). Implant bending was observed at 1 month postoperatively, without skin irritation, functional limitation, or implant breakage (b). The implant was electively removed at 1 year without complications (c).

Figure 3

A 15-year-old male patient underwent intramedullary nail fixation for a diaphyseal clavicle fracture. Skin irritation developed at the nail insertion site at 1 month postoperatively, necessitating early implant removal.

Figure 4

A 14-year-old male patient with a diaphyseal clavicle fracture underwent plate fixation (a), followed by plate removal 1 year postoperatively after confirmation of bone union (b). A refracture occurred 1 month later due to minor trauma (c). Conservative treatment using a figure-of-eight brace led to successful bone union within 3 months (d).