Clinical Efficacy Comparison of Bilaterally Threaded Elastic Locking Intramedullary Nailing Versus Minimally Invasive Percutaneous Locking Plate Fixation in Treating Midshaft Clavicle Fractures.

AIM: Midshaft clavicle fractures are a common form of upper extremity injury, with various treatment modalities available to stabilize displaced midshaft clavicular fractures. However, the optimal surgical method remains a matter of controversy. This study aimed to compare the clinical efficacy of bilaterally threaded elastic locking intramedullary nailing (BTELIN) versus minimally invasive percutaneous locking plate (MIPLP) fixation in treating midshaft clavicle fractures. METHODS: A retrospective cohort analysis was conducted on 110 patients with midshaft clavicle fractures treated between May 2021 and April 2024. Fifty-two patients received BTELIN fixation (Group A), while 58 patients underwent MIPLP fixation (Group B). Perioperative indicators (operative time, intraoperative blood loss, and hospital stay), fracture healing time, visual analog scale (VAS) for pain, Constant-Murley Shoulder Score, Disabilities of the Arm, Shoulder and Hand (DASH) score, shoulder range of motion (ROM), and postoperative complications were compared between the two groups. RESULTS: Compared with Group B, Group A exhibited significantly shorter operative time, less intraoperative blood loss, shorter hospital stay, and faster fracture healing time (p < 0.001). At 1 and 6 months postoperatively, VAS and DASH scores in Group A were significantly lower than those in Group B (p < 0.001), while Constant-Murley scores were significantly higher (p < 0.001). By 12 months postoperatively, there were no statistically significant differences in VAS or Constant-Murley scores between the two groups (p > 0.05); however, the DASH score in Group A remained significantly better than that in Group B (p < 0.05). Regarding shoulder ROM, Group A demonstrated superior movement in all directions at 3 months postoperatively (p < 0.001). At 12 months postoperatively, Group A maintained an advantage in external rotation and internal rotation (p < 0.05). There was no statistically significant difference in the incidence of various complications between the two groups (p > 0.05). CONCLUSIONS: Both BTELIN and MIPLP are effective methods for treating midshaft clavicle fractures. BTELIN offers several advantages in terms of minimal invasiveness, promotion of fracture healing, accelerated early functional recovery, and, in particular, preservation of shoulder rotation function. Therefore, BTELIN may represent a promising surgical option.