Does candidate for plate fixation selection improve the functional outcome after midshaft clavicle fracture? A systematic review of 1348 patients

Abstract

Introduction: The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate versus conservative) would give better functional outcome than random treatment allocation. Methods: We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 nonrandomized controlled trial studies encompassing a total of 1348 patients were included. Results: Patients treated with surgical management were found to have statistically superior Constant scores in nonrandomized controlled trials than in randomized controlled trials (94.76 AE 6.4 versus 92.49 AE 6.2; p < 0.0001). For conservative treatment, randomized controlled trials were found to have significantly better functional outcome. The prevalence of non-union (6.1%) did not show significant statistical difference between non-randomized controlled trial and randomized controlled trial studies. The functional outcome after surgical management was significantly higher than after conservative management in both randomized controlled trial and non-randomized controlled trial groups. The non-union rate after surgery (1.1% for both non-randomized controlled trial and randomized controlled trial) was significantly lower than following conservative treatment (9.9% non-randomized controlled trial versus 15.1% randomized controlled trial). Discussion: This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.

Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017

“…15,23 Thus, when surgical management of a clavicle fracture is being considered, proper patient selection is imperative, and the risk of nonunion should be assessed. 29 Risk factors for nonunion following clavicular fracture include advanced age, female sex, and the presence of comminution or displacement of the fracture. 29…”

“…29 Risk factors for nonunion following clavicular fracture include advanced age, female sex, and the presence of comminution or displacement of the fracture. 29…”

Ultrasound-Guided Clavipectoral Fascial Plane Block With Intermediate Cervical Plexus Block for Midshaft Clavicular Surgery: A Prospective Randomized Controlled Trial

“…About 81% of all clavicular fractures occur in the midshaft, 1 with surgical repair being considered the standard treatment option. 2 Considering the dermatomal distribution of cervical and brachial plexus branches, which innervates regions around the clavicle, 3 different regional anesthesia techniques have been utilized. 4,5 Among these, the combination of interscalene brachial plexus block (ISBPB) and intermediate cervical plexus block (ICPB) is considered a preferred technique.…”

Bicortical versus unicortical fixation of plated clavicular fractures: A biomechanical study

“…1 This is due to the recognition of fracture patterns associated with unsatisfactory results such as comminuted fractures, those with a displacement > 1.5 to 2 cm, and those with a third interposed vertical fragment. 2,3 In this subgroup of fractures, several clinical trials have shown that, compared to the non-surgical treatment, stabilization with plates and screws results in better functional results, a faster return to activities of daily living and sports, and a lower rate of major complications such as nonunion and malunion. [4][5][6][7] It is also well known that the use of locking screws provides superior stabilization and healing potential compared to standard non-locking screws for plate osteosynthesis, particularly in poor quality bone when there is comminution preventing fracture site compression.…”