WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Dr. Ammar M. Sheet Rashid 

ABSTRACT

Background: Midshaft clavicle fractures are common injuries in adults and may require operative fixation when significantly displaced or shortened. Elastic stable intramedullary nailing is a minimally invasive technique that preserves fracture biology and provides internal stabilization with a small surgical scar. Objectives: To evaluate the clinical outcomes and complications of elastic stable intramedullary nailing with selective plate conversion in adult patients with displaced midshaft clavicle fractures. Methods: This prospective observational study included 48 adult patients with displaced midshaft clavicle fractures initially planned for elastic stable intramedullary nailing at Al Salam Teaching Hospital from January 2023 to March 2026. Patients were assessed clinically and radiologically during follow-up at approximately 2 weeks, 6 weeks, 12 weeks, 6 months, and at the stage of nail removal when applicable. Operative outcome, fracture union, implant stability, complications, and final clinical outcome were evaluated. Results: Closed reduction with elastic nail fixation was successful in 20 patients (41.7%), while 25 patients (52.1%) required small incision open reduction followed by elastic nail fixation after failed closed reduction. Three patients (6.3%) with comminuted fractures were converted to open reduction with plate and screw fixation. Satisfactory clavicular alignment was achieved in 46 patients (95.8%), and stable implant position was confirmed in all patients. Early callus formation was observed in 44 patients (91.7%) at 6 weeks, while radiological union or progressive union was seen in 46 patients (95.8%) at 12 weeks. Complete union with maintained alignment was achieved in all patients by 6 months. The most common complication was medial nail-end irritation in 5 patients (10.4%), followed by delayed union in 3 patients (6.3%), superficial wound infection in 2 patients (4.2%), hypertrophic scar in 1 patient (2.1%), and implant migration in 1 patient (2.1%). No deep infection, neurovascular injury, nonunion, or refracture after implant removal was recorded. Final clinical outcome was excellent in 35 patients (72.9%), good in 11 patients (22.9%), and fair in 2 patients (4.2%). Conclusions: Elastic stable intramedullary nailing with selective plate conversion is a safe and effective operative strategy for selected adult midshaft clavicle fractures, providing high union rates, stable fixation, good cosmetic results, and favorable clinical outcomes with a low rate of major complications.

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