Plating versus intramedullary fixation for mid-shaft clavicle fractures: a systemic review and meta-analysis.

Yan Gao,Yue-Jv Liu,Hai-Li Wang,Wei Chen,Zhao-Yu Chen,Xu Li

doi:10.7717/peerj.1540

Abstract

Background. Plate fixation and intramedullary fixation are the most commonly used surgical treatment options for mid-shaft clavicle fractures; the latter method has demonstrated better performance in some studies.Objectives. Our aim was to critically review and summarize the literature comparing the outcomes of mid-shaft clavicle fracture treatment with plate fixation or intramedullary fixation to identify the better approach.Search Methods. Potential academic articles were identified from the Cochrane Library, MEDLINE (1966-2015.5), PubMed (1966-2015.5), EMBASE (1980-2015.5) and ScienceDirect (1966-2015.5). Gray studies were identified from the references of the included literature.Selection Criteria. Randomized controlled trials (RCTs) and non-RCTs comparing plate fixation and intramedullary fixation for mid-shaft clavicle fracture were included.Data Collection and Analysis. Two reviewers performed independent data abstraction. The I2 statistic was used to assess heterogeneity. A fixed- or random-effects model was used for the meta-analysis.Results. Six RCTs and nine non-RCTs were retrieved, including 513 patients in the intramedullary fixation group and 521 patients in the plating group. No significant differences in terms of the union rate and shoulder function were found between the groups. Patients in the intramedullary fixation group had a shorter operative time, less blood loss, smaller wound size, and shorter union time than those in the plating group. With respect to complications, significant differences were identified for all complications and major complications (wound infection, nonunion, implant failures, transient brachial plexopathy, and pain after 6 months). Similar secondary complications (symptomatic hardware, hardware irritation, prominence, numbness, hypertrophic callus) were observed in both groups.Conclusions. Intramedullary fixation may be superior to plate fixation in the treatment of mid-shaft clavicle fractures, with similar performance in terms of the union rate and shoulder function, better operative parameters and fewer complications.

Highlights

Clavicular fractures are common, comprising 2.6–10% of all fractures (O’Neill et al, 2011), and approximately 80% of clavicle fractures involve the middle shaft
The length of hospital stay was shorter in the intramedullary fixation (IF) group than in the plate fixation (PF) group, regardless of whether the metaanalysis was performed on all of the included studies (MD = −1.31; 95% confidence interval (CI) [−1.69 to −0.93]; P < 0.001; I 2 = 80%; Fig. 6), on Randomized controlled trials (RCTs) only (MD = −1.57; 95% CI [−2.30 to −0.84]; P < 0.001; I 2 = 85%), or on only the studies providing the original mean and standard deviation (MD = −0.98; 95% CI [−1.36 to −0.59]; P < 0.001)
The union time was shorter in the IF group than in the PF group when the analysis was performed only on RCTs (MD = −26.40; 95% CI [−46.20 to −6.61]; P = 0.009)

Summary

Introduction

Clavicular fractures are common, comprising 2.6–10% of all fractures (O’Neill et al, 2011), and approximately 80% of clavicle fractures involve the middle shaft. Plate fixation and intramedullary fixation are the most commonly used surgical treatment options for mid-shaft clavicle fractures; the latter method has demonstrated better performance in some studies. Our aim was to critically review and summarize the literature comparing the outcomes of mid-shaft clavicle fracture treatment with plate fixation or intramedullary fixation to identify the better approach. Randomized controlled trials (RCTs) and non-RCTs comparing plate fixation and intramedullary fixation for mid-shaft clavicle fracture were included. Intramedullary fixation may be superior to plate fixation in the treatment of mid-shaft clavicle fractures, with similar performance in terms of the union rate and shoulder function, better operative parameters and fewer complications

Objectives

Methods

Results

Conclusion