Abstract
BackgroundThe rate of operative fixation of acute midshaft clavicle fractures has exponentially increased in recent years; however, the rate of reoperation for symptomatic hardware removal remains high and the optimal fixation strategy unknown. This systematic review aimed to summarize available evidence for dual plating of acute displaced midshaft clavicle fractures.MethodsEMBASE, MEDLINE, and PubMed searches identified clinical studies evaluating dual plate fixation of acute midshaft clavicle fractures. Pooled analysis was performed using a random-effects model in RevMan 5.3.ResultsEleven studies including 672 patients were included. Hardware removal occurred in 4.4% and 12.3% of patients undergoing dual and single plate fixation, respectively. Compared to single plating, dual plating had significantly lower odds of hardware removal (P = 0.001) with no difference in union rates. There were no significant differences in reoperation (excluding hardware removal), complications, and patient-reported outcomes between the two groups (P > 0.05).ConclusionsThis study suggests that dual plating of acute displaced midshaft clavicle fractures may lead to lower rates of reoperation for symptomatic hardware removal without compromising fracture healing. Ultimately, well-designed randomized trials are needed to further investigate the findings from this systematic review.
Highlights
Midshaft clavicle fractures have traditionally been treated non-operatively with immobilization in a sling or a figure-of-eight bandage.[1,2] Early studies reported a non-union rate of 1% and negligible functional consequence with conservative management
The rate of operative fixation has exponentially increased following the publication of a landmark randomized controlled trial by the Canadian Orthopaedic Trauma Society which was the first of many level I studies to demonstrate higher union rates, decreased rates of symptomatic malunion, earlier return to function, and improved patient-reported outcomes with plate fixation of displaced midshaft clavicle fractures.[6,9,10,11]
Following application of inclusion and exclusion criteria, 11 articles were included in this systematic review[29,30,31,39,40,45,46,47,48,49,50,51,52] (Figure 1)
Summary
Midshaft clavicle fractures have traditionally been treated non-operatively with immobilization in a sling or a figure-of-eight bandage.[1,2] Early studies reported a non-union rate of 1% and negligible functional consequence with conservative management. The rate of operative fixation has exponentially increased following the publication of a landmark randomized controlled trial by the Canadian Orthopaedic Trauma Society which was the first of many level I studies to demonstrate higher union rates, decreased rates of symptomatic malunion, earlier return to function, and improved patient-reported outcomes with plate fixation of displaced midshaft clavicle fractures.[6,9,10,11]. The rate of operative fixation of acute midshaft clavicle fractures has exponentially increased in recent years; the rate of reoperation for symptomatic hardware removal remains high and the optimal fixation strategy unknown. Conclusions: This study suggests that dual plating of acute displaced midshaft clavicle fractures may lead to lower rates of reoperation for symptomatic hardware removal without compromising fracture healing. Well-designed randomized trials are needed to further investigate the findings from this systematic review
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