Middle third clavicle fractures are one of the most common types of fractures especially in young adults. But management part is still under debate. In olden days most of the fractures managed by conservative methods by arm sling and figure of eight bandage. But increasing demands, early mobilization of patients and anatomical fixation nowadays these fractures are managed by Open Reduction and Internal Fixation with plates and screws and Closed Reduction and Internal Fixation with Titanium Elastic Nailing System (TENS).In our study 15 patients treated with ORIF with plating, another 15 patients treated with CRIF/ORIF with elastic nailing. Though each procedure having advantages and disadvantages the functional outcome of surgical methods found to be better when compared to conservative methods. Elastic nailing not indicated for comminuted fractures and fracture nonunion. The advantage of intra medullary fixation and not disturbing the fracture hematoma are additive features of closed nailing. Keywords: Plate, intramedullary fixation, midshaft clavicle fractures IntroductionThe clavicle or collar bone is an S-shaped long bone which by its horizontal orientation forms a strut between the sternum and the scapula. A fracture of clavicle is one of the most common bony injuries rarely requires open reduction. In 94% of 122 patients with clavicular fractures, Stanley et al. found the mechanism of injury to be consistent with a direct blow rather than a fall on the outstretched hand, which is widely believed to be the most common mechanism of injury. In Neer's series of 45 fractures treated by open reduction, nonunion occurred in two (4%). Rowe reported nonunion in 0.8% of fractures treated by closed methods and in 3.7% treated by open reduction. Although displaced fractures of the clavicle often cannot be reduced and maintained in perfect position, cosmesis is acceptable and functional results are uniformly excellent. Even if the ends of the fragments heal in an overlapped or bayonet position with a substantial bony prominence, this is largely resorbed with time, and the mass decreases. Even the most fastidious patient usually is satisfied with the results.
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