A comparative study between the use of modified NICE knots as an auxiliary reduction-fixation technique and use of lag screw fixation with bridging plate for oblique and comminuted clavicular shaft fractures

This study is a prospective randomized clinical trial comparing two surgical techniques for treating oblique and comminuted midshaft clavicle fractures in adults. It evaluates open reduction and internal fixation using modified NICE knots versus conventional lag screw fixation with a bridging plate. The purpose is to determine whether modified NICE knots can provide effective fracture reduction and fixation while reducing surgical difficulty, operative time, and soft-tissue disruption. The project aims to assess and compare both techniques in terms of operative time, hospital stay, fracture-healing time, pain, shoulder function, upper-limb disability, return to activity, and postoperative complications. Patients are followed clinically and radiologically after surgery to evaluate both functional and healing outcomes. The expected outcome is to determine whether modified NICE knots are a safe and effective alternative to lag screw fixation, particularly in fractures with small or comminuted fragments where conventional fixation may be technically demanding. The study is expected to provide evidence that can guide surgeons in selecting the most efficient and biologically favorable fixation method for these fracture patterns.