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Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Low profile dual plate fixation using two mini fragment plates (< 2.7 mm thickness) is a relatively new technique and alternative to single plating for treating midshaft clavicle fractures. To date, no meta-analysis has been performed comparing these two techniques. Therefore, a systematic review and meta-analysis of observational studies and randomized clinical trials was performed comparing single plating to low profile dual plating for midshaft clavicle fractures.

Methods

PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate and re-intervention rate. Secondary outcomes include healing, operation duration and functional scores.

Results

Low profile dual plating has favourable outcomes regarding overall complication rate (8.1% vs. 22.5%, OR 0.3, 95% CI 0.2–0.7, I2 = 16%, p = 0.007) and re-intervention rate (6.1% vs. 16.1%, OR 0.3, 95% CI 0.1–0.9, I2 = 25%, p = 0.02). The largest contributing factor behind these differences was the high incidence of implant related complaints in the single plating group (4.7% vs. 11.6%, OR 0.4, 95% CI 0.2–0.9, I2 = 0%, p = 0.02). The use of low profile dual plating does not have a detrimental effect on healing with union being attained in 99% compared to 97.4% in the single plating group (OR 1.8, 95% CI 0.3–10.7, I = 0%, p = 0.5). Data on operating time and functional results is limited.

Conclusion

This meta-analysis shows that dual plating low profile plates for midshaft clavicle fractures is a safe procedure attaining the same union rates seen in patients treated with single plating. In addition, it seems to have a lower overall complication and re-intervention rate, mostly driven by the lower incidence of implant related complaints. Low profile dual plating, however, is a fairly new technique and should be further explored in respect to more differentiated endpoints to test whether these first findings are valid.

Level of evidence

III.

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Funding

This meta-analysis did not receive any funding.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland

    Ingmar Florin Rompen, Bryan Joost Marinus van de Wall, Isabelle Bünter, Nadine Diwersi, Franz Tillmann, Björn-Christian Link, Matthias Knobe & Frank Joseph Paulus Beeres

  2. Department of Surgery, Hand and Wrist Unit, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands

    Mark van Heijl

  3. Department of Orthopaedics, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany

    Filippo Migliorini

  4. Department of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland

    Bryan Joost Marinus van de Wall & Reto Babst

Authors
  1. Ingmar Florin Rompen
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  2. Bryan Joost Marinus van de Wall
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  8. Matthias Knobe
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  10. Frank Joseph Paulus Beeres
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Corresponding author

Correspondence to Frank Joseph Paulus Beeres.

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Conflict of interest

Ingmar F Rompen, Bryan JM van de Wall, Mark van Heijl, Isabelle Bünter, Nadine Diwersi, Franz Tillmann, Filippo Migliorini, Björn-Christian Link, Matthias Knobe, Reto Babst and Frank JP Beeres declare that they have no conflict of interest.

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Rompen, I.F., van de Wall, B.J.M., van Heijl, M. et al. Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies. Eur J Trauma Emerg Surg 48, 3063–3071 (2022). https://doi.org/10.1007/s00068-021-01845-3

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  • DOI: https://doi.org/10.1007/s00068-021-01845-3

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