Intramedullary fixation versus plate fixation in the treatment of displaced mid-shift clavicle fractures: A meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND: Elastic intramedullary nail and steel plate are two commonly used instruments for clavicle fracture, However, there are few comparative studies on the advantages and disadvantages of them. OBJECTIVE: To systematically evaluate the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures. METHODS: Articles about the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures were searched in PubMed, Embase, Science Direct and Cochrane Library, CNKI, WanFang and VIP databases from inception to March 2017. Two reviewers independently screened the articles, extracted data and evaluated the bias risk in the included studies according to the inclusion and exclusion criteria. Meta-analysis was performed using ReMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 21 studies were included, with 859 patients in the intramedullary fixation group and 831 patients in the plate fixation group. (2) The result of meta-analysis showed that the operation time [MD=-18.62, 95%CI (-20.75, -16.49)], blood loss [MD=-56.23, 95%C/(-68.02, -62.44)], incision length [MJ=-5.53, 95%C/(-6.56, -4.49)], hospitalization time [MD=-1.01, 95%C/(-1.13, -0.89)], and healing time [MD=-1.39, 95%C/ (-1.98, -0.80)] in the intramedullary fixation group were better than those of the plate fixation group. (3) At 6 months after surgery, the Disabilities of the Arm, Shoulder and Hand scores in the intramedullary fixation group were better than those in the plate fixation group (F < 0.05). The scores showed no significant difference between two groups at 12 months after surgery. Major complications [OR=0.61, 95%C/ (0.39, 0.93)] in the intramedullary fixation group were less than those in the plate fixation group. Minor complications and implant removal were similar between two groups. (5) Meta-analysis results imply that elastic intramedullary nail fixation for treating displaced mid-shift clavicle fractures is superior to plate fixation in surgery-related indexes, functional recovery and fracture healing, which can provide effective evidence for its clinical application.