Publication:

Functional outcomes after titanium elastic nailing of mid-shaft clavicle fractures in a rural tribal cohort of Western Maharashtra

Background Mid-shaft clavicle fractures are common injuries, often affecting young active individuals. Although plating has traditionally been used for displaced fractures, Titanium Elastic Nailing (TENS) offers a minimally invasive alternative with potential advantages of faster recovery, cosmesis, and ease of implant removal. Limited evidence exists on outcomes in rural tribal populations, where occupational demands and access to rehabilitation may differ from urban cohorts.

Methods This prospective observational study was conducted at a tertiary care teaching hospital in Western Maharashtra from January 2023 to June 2024. Thirty adult patients (mean age 34 years; 76.6% male) with displaced mid-shaft clavicle fractures underwent intramedullary fixation with TENS. Patients with open, medial, or lateral third fractures were excluded. Functional outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analogue Scale (VAS) for pain at baseline and scheduled follow-ups. Radiological union and complications were recorded.

Results Ninety percent of patients achieved radiological union by one month, increasing to 96.7% by three months. The mean union time was 12.2 weeks. At final follow-up, the mean CMS was 96.2, mean DASH score was 2.3, and mean VAS score improved from 7.1 preoperatively to 1.2. Complications were minor, including superficial infection (n=2), nail migration (n=2), skin irritation (n=3), and hypertrophic scarring (n=1). No nonunion, implant failure, or deep infection occurred.

Conclusions TENS is an effective and safe option for displaced mid-shaft clavicle fractures in rural tribal patients, providing excellent functional outcomes, reliable union, and minimal complications. Its minimally invasive nature makes it particularly suitable for resource-limited settings.