Plate fixation versus intramedullary fixation for clavicle fractures: a meta-analysis

doi:10.3969/j.issn.2095-4344.2016.22.020

Abstract

Abstract:

BACKGROUND: Plate fixation or intramedullary fixation for clavicle fractures has remained a matter of debate. At present, there is a need for a higher level of evidence to evaluate the advantages and disadvantages of two different surgical methods.

OBJECTIVE: To assess the clinical efficacy of intramedullary fixation versus plate fixation in the treatment of clavicle fractures.

METHODS: We conducted a computerized search of the electronic databases like Cochrane Library, PubMed, Embase, OVID, CBM, CNKI, Wanfang and VIP for relevant randomized controlled trials on plate fixation or intramedullary fixation for clavicle fractures. The quality of the included studies was independently assessed with RevMan 5.3 software. The meta-analysis was performed in Stata 13.0.

RESULTS AND CONCLUSION: Eight randomized controlled trials with 527 patients were included in this meta-analysis. The meta-analysis results showed union time, surgery time, incision length, hospital stay and infection rate were less in the intramedullary fixation group than in the plate fixation group (P < 0.05). No significant difference in shoulder function score, upper limb function score, fracture nonunion and refracture was determined between the two groups (P < 0.05). The current evidences suggested that intramedullary fixation is the optimum choice in the treatment of clavicle fractures.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Fractures, Bone, Internal Fixators, Evidence-Based Medicine, Tissue Engineering

CLC Number:

R318

Qiu Hao, Lu Min-peng, Luan Fu-jun, Wei Zhi-hui, Ma Ji-kun, Zhang Ming-hua. Plate fixation versus intramedullary fixation for clavicle fractures: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(22): 3337-3344.

Figures/Tables 11

References

[1] Brin YS,Palmanovich E,Dolev E,et al.Displaced mid-shaft clavicular fractures: is conservative treatment still preferred?Isr Med Assoc J.2014;16(12): 748-752.
[2] Lechler P,Sturm S,Boese CK,et al.Surgical complications following ESIN for clavicular mid-shaft fractures do not limit functional or patient-perceived outcome.Injury.2015. pii: S0020-1383(15)00747-0. doi: 10.1016/j.injury.2015.11.025. [Epub ahead of print]
[3] 李恩琪,袁天祥,马宝,等.锁骨骨折手术治疗与并发症控制研究进展[J].中国矫形外科杂志, 2013,21(20): 2092-2094.
[4] Fuglesang HF,Flugsrud GB,Randsborg PH,et al.Radiological and functional outcomes 2.7 years following conservatively treated completely displaced midshaft clavicle fractures.Arch Orthop Trauma Surg. 2016;136(1):17-25.
[5] Ersen A,Atalar AC,Birisik F,et al.Comparison of simple arm sling and figure of eight clavicular bandage for midshaft clavicular fractures: a randomised controlled study. Bone Joint J.2015;97-B(11):1562-1565.
[6] Robinson CM,Court-Brown CM,McQueen MM,et al.Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture.J Bone Joint Surg Am. 2004;86-A(7):1359-1365.
[7] McKee MD,Pedersen EM,Jones C,et al.Deficits following nonoperative treatment of displaced midshaft clavicular fractures.J Bone Joint Surg Am.2006;88(1): 35-40.
[8] 刘川.锁骨中段骨折修复:重建钢板前置与上置的生物力学差异[J].中国组织工程研究, 2014,18(53):8646-8650.
[9] 孙宝柱,张振华,何钢.不锈钢材质T形锁定板修复锁骨近端骨折及胸锁关节脱位[J].中国组织工程研究, 2015, 19(21):3414-3418.
[10] Fridberg M,Ban I,Issa Z,et al.Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases.Int Orthop. 2013;37(4):689-692.
[11] Liu PC,Hsieh CH,Chen JC,et al.Infection After Surgical Reconstruction of a Clavicle Fracture Using a Reconstruction Plate: A Report of Seven Cases.Kaohsiung J Med Sci.2008;24(1):45-49.
[12] Liu GD,Tong SL,Ou S,et al.Operative versus non-operative treatment for clavicle fracture: a meta-analysis.Int Orthop.2013;37(8):1495-1500.
[13] Wang YC,Fu YC,Chou SH,et al.Titanium Elastic Nail versus plate fixation of displaced midshaft clavicle fractures: A retrospective comparison study Kaohsiung J Med Sci. 2015;31(9):473-479.
[14] Denard PJ,Koval KJ,Cantu RV,et al.Management of midshaft clavicle fractures in adults. Am J Orthop (Belle Mead NJ).2005;34(11):527-536.
[15] 饶义康,饶放萍,钟娟,等.股骨颈空心螺钉髓内固定与重建钢板治疗成人锁骨骨折的疗效[J].实用临床医学,2014, 15(10):34-36.
[16] Andrade-Silva FB,Kojima KE,Joeris A,et al.Single, superiorly placed reconstruction plate compared with flexible intramedullary nailing for midshaft clavicular fractures: a prospective, randomized controlled trial.J Bone Joint Surg Am.2015;97(8):620-626.
[17] Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures.J Orthop Traumatol. 2011;12(4):185-192.
[18] Ferran NA,Hodgson P,Vannet N,et al.Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg.2010;19(6): 783-789.
[19] Lee YS,Huang HL,Lo TY,et al.Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation.Int Orthop. 2008; 32(4):541-545.
[20] Narsaria N,Singh AK,Arun GR,et al.Surgical fixation of displaced midshaft clavicle fractures: elastic intramedullary nailing versus precontoured plating.J Orthop Traumatol. 2014;15(3):165-171.
[21] van der Meijden OA,Houwert RM,Hulsmans M,et al.Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial.J Bone Joint Surg Am. 2015;97(8):613-619.
[22] Zehir S,Zehir R,Sahin E,et al.Comparison of novel intramedullary nailing with mini-invasive plating in surgical fixation of displaced midshaft clavicle fractures. Arch Orthop Trauma Surg.2015;135(3):339-344.
[23] 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.Int Orthop. 2015;39(2):319-328.
[24] Chen Y,Yang Y,Ma X,et al.A biomechanical comparison of four different fixation methods for midshaft clavicle fractures.Proc Inst Mech Eng H.2016;230(1):13-19.
[25] Nuzzo MS,Adamson GJ,Lee TQ,et al.Biomechanical Comparison of Fracture Risk Created by 2 Different Clavicle Tunnel Preparations for Coracoclavicular Ligament Reconstruction.Orthop J Sports Med.2014; 2(11):2325967114555478.
[26] Houwert RM,Wijdicks FJ,Steins Bisschop C,et al.Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop.2012;36(3):579-585.
[27] Barlow T,Beazley J,Barlow D.A systematic review of plate versus intramedullary fixation in the treatment of midshaft clavicle fractures.Scott Med J. 2013;58(3): 163-167.
[28] Zhang B,Zhu Y,Zhang F,et al.Meta-analysis of plate fixation versus intramedullary fixation for the treatment of mid-shaft clavicle fractures.Scand J Trauma Resusc Emerg Med.2015;23:27.
[29] Wijdicks FJ,Houwert M,Dijkgraaf M,et al.Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison.Int Orthop.2012;36(10): 2139-2145.
[30] Chen YF,Wei HF,Zhang C,et al.Retrospective comparison of titanium elastic nail (TEN) and reconstruction plate repair of displaced midshaft clavicular fractures.J Shoulder Elbow Surg.2012;21(4): 495-501.