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A Prospective Study to Assess Radiological and Functional Outcomes in the Surgical Management of Displaced Middle Third Clavicle Fractures Fixed with TENS Titanium Elastic Intra-Medullary Nail

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Original Article | Vol 12 | Issue 1 | January-June 2026 | page: 36-43 | Sanjay Chhawra, Rahul Aggarwal, Raman Jain, Amit Gupta, Amit Nagar, Rishav Anand, Rajat Mudgal, Hritik Swarnkar

DOI: https://doi.org/10.13107/ti.2026.v12.i01.86

Submitted: 21/02/2026; Reviewed: 29/03/2026; Accepted: 02/04/2026; Published: 10/04/2026

Authors: Sanjay Chhawra [1], Rahul Aggarwal [1], Raman Jain [1], Amit Gupta [1], Amit Nagar [1], Rishav Anand [1], Rajat Mudgal [1], Hritik Swarnkar [1]

[1] Department of Orthopaedics, Jaipur Golden Hospital, Sector 3 Rohini, New Delhi, India.

Address of Correspondence

Dr. Sanjay Chhawra,

Department of Orthopaedics, Jaipur Golden Hospital, Sector 3 Rohini, New Delhi, India.

E-mail: sanjaychhawra@yahoo.com

Abstract

Introduction: Clavicle fractures are common injuries, accounting for 5%-10% of total fractures. The middle third of the clavicle is fractured in 69% of cases, the distal third is fractured in 28% of cases, and the proximal third is fractured in 3% of cases. Early displaced midshaft clavicle fractures were treated conservatively after studies it has being defined that there is nonunion with decreased functional outcome. Surgery is indicated in the event of substantial fracture displacement and accompanying neurovascular damage. Plate osteosynthesis is the conventional approach for treating fractures requiring internal fixation with various complications. Intramedullary fixation using the titanium elastic nailing system (TENS) is becoming a more preferred method for internal fixation of displaced mid-clavicular fractures with minimal incision and better functional outcomes.

Methodology: A prospective study was undertaken with a sample size of 30 patients over two years, with all cases followed up for 12 months. A complete clinical examination of the patient was conducted to evaluate associated injury radiological assessment of the intramedullary diameter of the clavicle was also done. Following approval and clearance from the institutional ethics committee, patients who met the inclusion criteria were enrolled in the study after providing informed consent. The functional outcomes of the study included ASES, CONSTANT, and VAS.

Result: The mean operation time was 40 min, 3 days after surgery the VAS score was 2-3, Union in weeks mean was 10 weeks and functional score after 12 months ASES Score 3 cases of 51-70 22 cases of 71-90 5 cases of 91-100 and at last CONSTANT Score- 12th month 1 cases 56-70 15 cases of 71-85 14 cases of 86-100

Conclusion: TENS is a safe, stable, minimally invasive surgical technique in indicated cases with reduced duration of the surgery, decrease the surgical site morbidity, early mobilization, faster return to daily activities, excellent cosmetic results with a lower complication rate.

Keywords: TENS, Clavicle, Union

References

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How to Cite this article: Chhawra S, Aggarwal R, Jain R, Gupta A, Nagar N, Anand R, Mudgal R, Swarnkar H | A Prospective Study to Assess Radiological and Functional Outcomes in the Surgical Management of Displaced Middle Third Clavicle Fractures Fixed with TENS Titanium Elastic Intra-Medullary Nail | January-June 2026; 12(1): 36-43 |

https://doi.org/10.13107/ti.2026.v12.i01.86

 

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Tens Nailing in Fracture Clavicle – A Case Series

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Vol 8 | Issue 2 | July-December 2022 | page: 17-20 | Mohd Danish, Hemant Gupta, Ashish Sao, Ravi Kant

DOI: https://doi.org/10.13107/ti.2022.v08i02.029

Authors: Mohd Danish [1], Hemant Gupta [1], Ashish Sao [1], Ravi Kant [1]

[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence

Dr. Mohd Danish,

Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

E-mail: danish.shan@gmail.com

Abstract

INTRODUCTION: Clavicle is one of the most commonly fractured bones accounting for 2.6 – 4 % of all the fractures. 69 – 82% of these occur in middle third of clavicle, 73 % of which are displaced midshaft clavicular fractures). Surgery has been indicated for displaced fractures of clavicle, one with NV compromise and skin tenting. Intramedullary fixation for clavicular fractures was first described by Peroni in 1950. The use of a TENS nail carries advantages of less soft tissue compromise, less operative time, better cosmetic results, load sharing fixation with relative stability that encourages copious callus formation.

MATERIAL AND METHOD: A prospective review of 20 patients who presented to our institute between January 2021 and June 2022 with displaced midshaft clavicle fractures and treated with TENS nailing was carried out. All the patients had Constant Murley score and DASH score, which were done at 6 and 12 weeks.

RESULTS: All the patients achieved clinical and radiological union at a mean of 19.6 ± 6.67.80% of the patient had excellent Constant Murley score on follow up. Based on the assessment parameters (Disability of Arm Shoulder and Hand) Score, the mean DASH score was 25.03 ± 3.36 (range 20-30), 18.56 ± 3.46 (range 14-25) at the end of 6 weeks and 12 weeks respectively.

CONCLUSION: The intramedullary fixation using TENS of midshaft clavicle fractures is a safe minimally invasive technique in indicated cases and in our hands, it provides good functional outcome and cosmetic results.

KEYWORDS: Tens, Clavicle, Fracture, Intramedullary

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How to Cite this article: Danish M, Gupta H, Sao A, Kant R | Tens Nailing in Fracture Clavicle – A Case Series | July-December 2022; 8(2): 17-20 |  https://doi.org/10.13107/ti.2022.v08i02.029

 

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