Implant fixationversus conservative treatment for clavicle fractures：a meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND:It is stil disputed at present about the treatment selection for clavicle fractures, operative or conservative treatment. OBJECTIVE:To evaluate the effects of operative and non-operative (conservative) treatment for clavicle fractures with the method of meta-analysis. METHODS: We retrieved PUBMED, EMBASE, OVID, Cochrane library, Science Direct, Springer Link, China National Knowledge Infrastructure and Wanfang Database for articles on treatment of clavicle fractures published from January 2000 to December 2013. According to specific inclusion and exclusion criteria, relevant literatures about treatments of clavicle fractures were searched for data source extraction, which were used for meta-analysis using Review Manager 5.0 software. RESULTS AND CONCLUSION:Six randomized controled trials were included, including 570 patients. Meta-analysis results demonstrated that for clavicle fractures, implant fixation could decrease nonunion rate [RR=0.16, 95%CI(0.07, 0.38),P < 0.000 1], malunion rate [RR=0.15, 95%CI(0.07, 0.34),P < 0.000 01], delayed union rate [RR=0.20, 95%CI(0.06, 0.70),P=0.01] and the incidence of residual pain at 1 year after treatment [RR=0.24, 95%CI(0.12, 0.51),P=0.000 2], could elevate Constant Score [MD=3.68, 95%CI(1.61, 5.76),P=0.000 5]. However, it was not concluded that fixation could reduce the incidence of neurological complications [RR=0.63, 95%CI(0.06, 0.70),P=0.22]. It is suggested that implant fixation for clavicle fractures obtained good clinical effects. However, due to the disadvantages of the included literatures, we stil needed high-quality multicenter randomized controled trials to further verify conclusions, and should pay more attention on patients’ individual conditions when the therapeutic methods for clavicle fractures were selected in the clinic.