Meta-analysis of plate fixation versus intramedullary fixation for the treatment of mid-shaft clavicle fractures.

Bing Zhang,Ye Tian,Fei Zhang,Yanbin Zhu,Wei Chen,Yingze Zhang

doi:10.1186/s13049-015-0108-0

Abstract

BackgroundThis systematic review and meta-analysis aims to critically compare the outcomes of plate fixation (PF) versus intramedullary fixation (IF) for the treatment of mid-shaft clavicle fractures.MethodsRelevant original studies were searched in electronic databases of Medline, Embase, Cochrane central database and CNKI (all through October 2014). The study was performed according to the PRISMA statement. Studies that investigated the comparing effectiveness or complications between both groups and provided sufficient data of interest were included in this meta-analysis.ResultsThirteen studies fulfilling inclusion and exclusion criteria were included in this meta-analysis, which included 479 participants in PF group and 457 in IF group. Compared to PFs, IFs outperformed PFs associated with a reduced surgery time, a shorter incision, rapid union time, better shoulder function recovery at 6 months and fewer complications of symptomatic hardware, refracture after hardware removal and hypertrophic scar. In other aspects such as functional recovery at 12 months and 24 months follow-up, shoulder motion range, complications of superficial infection,temporary brachial plexus lesion, nonunion, malunion, delayed union, implant failure, major revision needed, both techniques were comparable.ConclusionsThe present evidence from this meta-analysis suggested that IF was a more advantaged method for the treatment of midshaft clavicle fractures. This present study might aid surgeons in making evidence-based decision about optimal surgical treatment of mid-shaft clavicular fracture.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0108-0) contains supplementary material, which is available to authorized users.

Highlights

Clavicular fracture accounts for 2.6–10% of all fractures, and approximately 80% of the sites involved in adult patients were mid-shaft clavicle [1,2,3,4]
Search strategy A computerized literature search was initially performed in databases of PubMed, Medline, Embase and Chinese National Knowledge Infrastructure (CNKI) for related studies published between January 1990 and October 2014
The inclusion criteria were as follows: (1) randomised controlled trials or case–control studies or cohort studies comparing the results between intramedullary fixation (IF) and plate fixation (PF) for treating mid-shaft clavicular fractures; (2) at least one of comparing results of interest must be provided in the original study; (3) age of participants in both groups was not older than 65 years, namely, young active patients; (4) sufficient data were provided for estimating an odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CIs)

Summary

Introduction

Clavicular fracture accounts for 2.6–10% of all fractures, and approximately 80% of the sites involved in adult patients were mid-shaft clavicle [1,2,3,4]. Displacement occurs in over 70% of the mid-shaft clavicular fractures [4,5]. There are various techniques for fixation of midshaft clavicle fractures including multiple forms of plating and intramedullary devices. IF advantaged over PF in preserving the soft tissue envelope, periosteum, and vascular integrity [24,25] and even early hardware migration appears to be solved by improved device of locked IM, but the biomechanical property of less stability has to be addressed [26]. This systematic review and meta-analysis aims to critically compare the outcomes of plate fixation (PF) versus intramedullary fixation (IF) for the treatment of mid-shaft clavicle fractures

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Conclusion