Background/Aim: Background: Midshaft clavicle fractures represent a significant proportion of traumatic shoulder girdle injuries. Although non-operative treatment has historically been the standard, recent studies have revealed high rates of malunion and nonunion with conservative management, especially in displaced fractures. As a result, operative management using either plating or intramedullary nailing techniques is increasingly preferred. However, the ideal fixation method remains debated.

Objectives: To compare the clinical, radiological, and functional outcomes of two common surgical techniques for displaced midshaft clavicle fractures: (1) Open reduction and internal fixation with anatomically contoured locking compression plates and (2) Intramedullary fixation using Titanium Elastic Nailing System (TENS).

Methods: This prospective, randomized comparative study was conducted at SS Institute of Medical Sciences & Research Centre, Davangere from February 2023 to February 2025. A total of 40 patients with Robinson type 2B midshaft clavicle fractures were enrolled and randomized into two equal groups. Group A (n=20) underwent plate fixation, and Group B (n=20) underwent TENS fixation. Patients were followed clinically and radiologically at regular intervals up to 6 months. Constant-Murley shoulder score was used to evaluate functional outcomes. Radiological union was assessed through standard imaging. Complications, including infection, implant failure, and hardware-related symptoms, were recorded.

Results: The mean age of participants was 32.92 ± 9.18 years, with a male predominance. Road traffic accidents were the most common mode of injury. Right-sided fractures were slightly more common. Clinical and radiological union occurred significantly earlier in the TENS group (mean radiological union at 7.4 weeks) compared to the plate group (mean 9.3 weeks). At 6 months, the mean Constant-Murley score was significantly higher in the TENS group (90.4) than in the plate group (85.3). The TENS group experienced fewer complications, with only one case of nail backout and one superficial infection, whereas the plate group had two cases of wound dehiscence, two instances of implant prominence, and one superficial infection.