Plate fixation versus intramedullary fixation for midshaft clavicle fractures: Meta-analysis of complications and functional outcomes

Abstract

ObjectiveThis analysis critically compares publications discussing complications and functional outcomes of plate fixation (PF) versus intramedullary fixation (IF) for midshaft clavicle fractures.MethodsRelevant studies published between January 1990 and October 2014, without language restrictions, were identified in database searches of PubMed®, Medline®, Embase and the Chinese National Knowledge Infrastructure (CNKI). Studies that compared postoperative complications and functional outcomes between PF and IF for midshaft clavicle fractures, and provided sufficient data for analysis, were included in this meta-analysis.ResultsAfter strict evaluation, 12 studies were included in this meta-analysis. Studies encompassed 462 participants in the PF group and 440 in the IF group. Study participants were followed up for ≥1 year. Outcomes were superior with IF compared with PF in terms of shoulder constant score at 6-month follow-up, fewer symptomatic hardware complications, lower rate of refracture after hardware removal and less hypertrophic scarring. In other aspects, such as functional recovery at 12-months and 24-months, Disability of Arm, Shoulder and Hand (DASH) questionnaire results at 12-month follow-up, shoulder motion range, rates of superficial infection, temporary brachial plexus lesion, nonunion, malunion, delayed union, implant failure and need for major revision, both techniques were similar.ConclusionsFindings of this meta-analysis suggest that, in many respects, IF was superior to PF for the management of midshaft clavicle fractures. This finding could aid surgeons in making decisions on the optimum internal fixation pattern for midshaft clavicular fractures.

Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

“…In the last years multiple meta-analysis comparing the gold standard of plate fixation and intramedullary devices (irrespective of device or plate type) for the management of midshaft clavicle fractures have been published. [82][83][84][85][86][87][88][89] These studies report similar [82][83][84][86][87][88] or superior [85,89] functional outcomes and union rates in the intramedullary fixation group. Furthermore, most report a higher rate of complications (such as infection, refracture rate) and increased surgical time when using plate fixation, making an evaluation of the devices described in the present study even more relevant.…”

Biomechanical performance of an intramedullary Echidna pin for fixation of comminuted mid‐shaft clavicle fractures

“…Intramedullary fixation of mid‐shaft clavicular fractures has been shown to reduce refracture rate and improved cosmetic outcomes compared to plate fixation; however, smooth profile pins such as the Steinmann and Knowles pin risk migration, while post‐operative removal of threaded devices such as the Herbert screw present technical challenges and risk of bone fracture . The Echidna pin was designed to anchor into bone surrounding the intramedullary canal using retractable spines, reducing the risk of migration and increasing construct stability, whilst allowing for ease of device removal .…”

“…Surgical treatment of displaced clavicle fractures is indicated in cases of non‐union with concomitant pain, severe malpositioning, skin tenting and a fracture gap greater than half of one clavicle diameter, as well as open fractures, and has been associated with reduced rates of non‐union post‐operatively . Plate fixation is the gold standard of surgical clavicle fracture repair, but is known to result in greater wound size and associated skin numbness, increased risk of infection, reduced muscular stability, prolonged healing and neurovascular complications resulting from screw penetration through the far cortex of the clavicle …”

“…Intramedullary clavicle fracture fixation bridges clavicle fragments via small incisions on the lateral aspect of the shoulder and over the fracture site, which can decrease wound infection risk, reduce pain and improve healing times compared with plated fixation . This has been shown to reduce operating times, and has decrease refracture rates compared to those of plated fixation due to the absence of fixation screw holes . Titanium elastic nails, Rockwood pins and non‐threaded Knowles pins can be easily placed intraoperatively, safely removed after healing and have been employed with good clinical, functional and cosmetic outcomes; however, smooth intramedullary devices are prone to migration, which can ultimately risk injury of adjacent neurovascular structures and viscera .…”

A comparison of the cost-effectiveness of intramedullary nail fixation and locking plate fixation in the treatment of adult patients with an extra-articular fracture of the distal tibia

“…The same interventions have been compared in different clinical contexts, for example, for the treatment of midshaft clavicle fractures [31,32] ; however the costeffectiveness evidence in those contexts remains limited [33] .…”