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Management of the mid-shaft clavicle fractures using plate fixation versus intramedullary fixation: an updated meta-analysis

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Abstract

Purpose

This meta-analysis of randomised controlled trials (RCTs) aimed to investigate the comparative outcomes between plate fixation and intramedullary fixation for management of mid-shaft clavicle fractures.

Methods

Relevant original studies were searched in electronic databases of PubMed, Medline, Embase and CNKI (all through October 2014). RCTs that investigated the effectiveness or complications between both groups and provided sufficient data of interest were included in this meta-analysis.

Results

Five RCTs fulfilled inclusion and exclusion criteria and were included in this meta-analysis, with 128 participants in a plate fixation (PF) group and 157 in an intramedullary fixation (IF) group. Patients were followed up for at least one year in all the studies. Compared to PFs, IF is a better alternative for treatment of MSCFs than PF, with a reduced surgery time, a shorter incision, rapid union time, better shoulder function at one year and fewer complications such as infection, symptomatic hardware and hypertrophic scar. In other aspects such as complications of implant failure, refracture and nonunion, both techniques were comparable.

Conclusions

If the surgery is indicated, intramedullary fixation has more advantages than plate fixation for treatment of mid-shaft clavicular fracture. This definitive conclusion could aid surgeons in making evidence-based decisions when selecting an optimal fixation pattern.

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References

  1. Robinson CM (1998) Fractures of the clavicle in the adult Epidemiology and classification. J Bone Joint Surg (Br) 80:476–484

    Article  CAS  Google Scholar 

  2. Zhang YZ (2012) Clinical epidemiology of orthopedic trauma, 1st edn. Thieme, Stuttgart & New York, pp 564–580

    Google Scholar 

  3. Khan LA, Bradnock TJ, Scott C, Robinson CM (2009) Fractures of the clavicle. J Bone Joint Surg Am 91:447–460

    Article  PubMed  Google Scholar 

  4. Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Should Elbow Surg 11:452–456

    Article  Google Scholar 

  5. Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop Relat Res 300:127–132

    PubMed  Google Scholar 

  6. Robinson CMC-BC, McQueen MM, Wakefield AE (2004) Estimating the risk of non-union following nonoperative treatment of a clavicular fracture. Clin Orthop Relat Res 86:1359–1365

    Google Scholar 

  7. Society COT (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89:1–10

    Google Scholar 

  8. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD (2005) Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 19:504–507

    Article  PubMed  Google Scholar 

  9. Liu GD, Tong SL, Ou S, Zhou LS, Fei J, Nan GX, Gu JW (2013) Operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop 37:1495–1500

    Article  PubMed Central  PubMed  Google Scholar 

  10. Zhu Z, Nie L (2013) Comment on Liu et al.: operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop 37:1621

    Article  PubMed Central  PubMed  Google Scholar 

  11. Ye C, Liao G, He S, Zhang Z (2013) Comment on Liu et al.: operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop 37:1619–1620

    Article  PubMed Central  PubMed  Google Scholar 

  12. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS (2009) Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma 23:106–112

    Article  PubMed  Google Scholar 

  13. Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R (2006) Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma 20:680–686

    Article  PubMed  Google Scholar 

  14. Chen YF, Wei HF, Zhang C, Zeng BF, Zhang CQ, Xue JF (2012) Retrospective comparison of titanium elastic nail (TEN) and reconstruction plate repair of displaced midshaft clavicular fractures. J Should Elbow Surg 21:495–501

    Article  Google Scholar 

  15. Verborgt O, Pittoors K, Van Glabbeek F, Declercq G, Nuyts R, Somville J (2005) Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg 71:17–21

    PubMed  Google Scholar 

  16. Bostman O, Manninen M, Pihlajamaki H (1997) Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 43:778–783

    Article  CAS  PubMed  Google Scholar 

  17. Lee YS, Huang HL, Lo TY, Hsieh YF, Huang CR (2008) Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation. Int Orthop 32:541–545

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Nakayama M, Gika M, Fukuda H, Yamahata T, Aoki K, Shiba S (2009) Migration of a Kirschner wire from the clavicle into the intrathoracic trachea. Ann Thorac Surg 88:653–654

    Article  PubMed  Google Scholar 

  19. Golish SR, Oliviero JA, Francke EI, Miller MD (2008) A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res 3:28–32

    Article  PubMed Central  PubMed  Google Scholar 

  20. Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M (2012) Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 36:579–585

    Article  PubMed Central  PubMed  Google Scholar 

  21. Barlow T, Beazley J, Barlow D (2013) A systematic review of plate versus intramedullary fixation in the treatment of midshaft clavicle fractures. Scott Med J 58:163–167

    Article  CAS  PubMed  Google Scholar 

  22. Duan X, Zhong G, Cen S, Huang F, Xiang Z (2011) Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Should Elbow Surg Am 20:1008–1015

    Article  Google Scholar 

  23. Assobhi JE (2011) Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol 12:185–192

    Article  PubMed Central  PubMed  Google Scholar 

  24. Narsaria N, Singh AK, Arun GR, Seth RR (2014) Surgical fixation of displaced midshaft clavicle fractures: elastic intramedullary nailing versus precontoured plating. J Orthop Traumatol 15:165–171

    Article  PubMed Central  PubMed  Google Scholar 

  25. Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y (2001) Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 12:232–236

    Article  CAS  PubMed  Google Scholar 

  26. Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826

    Article  CAS  PubMed  Google Scholar 

  27. Wei J, Yang TB, Luo W, Qin JB, Kong FJ (2013) Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res 41:265–275

    Article  PubMed  Google Scholar 

  28. Wijdicks FJ, Houwert M, Dijkgraaf M, de Lange D, Oosterhuis K, Clevers G (2012) Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. Int Orthop 36:2139–2145

    Article  PubMed Central  PubMed  Google Scholar 

  29. Lee YS, Lin CC, Huang CR, Chen CN, Liao WY (2007) Operative treatment of midclavicular fractures in 62 elderly patients: Knowles pin versus plate. Orthopedics 30:959–964

    PubMed  Google Scholar 

  30. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO (2010) Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Should Elbow Surg Am 19:783–789

    Article  Google Scholar 

  31. Thyagarajan DS, Day M, Dent C, Williams R, Evans R (2009) Treatment of mid-shaft clavicle fractures: a comparative study. Int J Should Surg 3:23–27

    Article  Google Scholar 

  32. Fu TH, Tan BL, Liu HC, Wang JW (2012) Anatomical reduction for treatment of displaced midshaft clavicular fractures: Knowles pinning vs. reconstruction plating. Orthopedics 35:e23–e30

    PubMed  Google Scholar 

  33. Kleweno CP, Jawa A, Wells JH, O’Brien TG, Higgins LD, Harris MB (2011) Midshaft clavicular fractures: comparison of intramedullary pin and plate fixation. J Should Elbow Surg Am 20:1114–1117

    Article  Google Scholar 

  34. Fridberg M, Ban I, Issa Z, Krasheninnikoff M, Troelsen A (2013) Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases. Int Orthop 37:689–692

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

We are grateful to G. Xu and B. Liu of the Department of Orthopaedics, and to X. Zhang and Q. Zhang of the Department of Statistics and Applications for their kind assistance.

Conflict of authors’ statement

All the authors declare that they have no conflict of interest with any organization that sponsored the research.

Authors’ contributions

Yingze Zhang designed the study; Fei Zhang and Ye Tian searched relevant studies and abstracted the data; Wei Chen and Tianhua Dong analysed and interpreted the data; Yanbin Zhu and Ye Tian wrote the manuscript and Yingze Zhang approved the final version of the manuscript.

Funding support

No organization sponsored the research.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, People’s Republic of China

    Yanbin Zhu, Ye Tian, Tianhua Dong, Wei Chen, Fei Zhang & Yingze Zhang

  2. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China

    Yanbin Zhu, Ye Tian, Tianhua Dong, Wei Chen, Fei Zhang & Yingze Zhang

Authors
  1. Yanbin Zhu
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  2. Ye Tian
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  3. Tianhua Dong
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  4. Wei Chen
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  5. Fei Zhang
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  6. Yingze Zhang
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Corresponding author

Correspondence to Yingze Zhang.

Additional information

Yanbin Zhu and Ye Tian contributed equally to this manuscript.

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Zhu, Y., Tian, Y., Dong, T. et al. Management of the mid-shaft clavicle fractures using plate fixation versus intramedullary fixation: an updated meta-analysis. International Orthopaedics (SICOT) 39, 319–328 (2015). https://doi.org/10.1007/s00264-014-2655-9

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  • DOI: https://doi.org/10.1007/s00264-014-2655-9

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