title: Surgical treatment of Neer type-II fractures of the distal clavicle: a meta-analysis.
abstract: OBJECTIVE
  Type-II distal clavicle fractures according to the Neer classification are generally operated because of the high non-union rate after non-operative treatment. Several surgical techniques have been developed in order to reduce the non-union rate and improve functional outcome. This meta-analysis overviews the available surgical techniques for type-II distal clavicular fractures.
  
  
  METHODS
  We searched the literature systematically. No comparative studies were found. 21 studies (8 prospective and 13 retrospective cohort studies) were selected for the meta-analysis. Data were pooled for 5 surgical outcome measures: function, time to union, time to implant removal, major complications, and minor complications.
  
  
  RESULTS
  The 21 studies selected included 350 patients with a distal clavicular fracture. Union was achieved in 98% of the patients. Functional outcome was similar between the treatment modalities. Hook-plate fixation was associated with an 11-fold increased risk of major complications compared to intramedullary fixation and a 24-fold increased risk compared to suture anchoring.
  
  
  CONCLUSIONS
  If surgical treatment of a distal clavicle fracture is considered, a fixation procedure with a low risk of complications and a high union rate such as plate fixation or intramedullary fixation should be used. The hook-plate fixation had an increased risk of implant-related complications.
authors.affiliation: Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands. s.a.stegeman@lumc.nl
authors.forename: Sylvia A
authors.initials: SA
authors.lastname: Stegeman
authors.forename: Hakan
authors.initials: H
authors.lastname: Nacak
authors.forename: Koen H J
authors.initials: KH
authors.lastname: Huvenaars
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Pieta
authors.initials: P
authors.lastname: Krijnen
authors.forename: Inger B
authors.initials: IB
authors.lastname: Schipper
mesh_terms: D002968:Clavicle / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D005599:Fractures, Ununited / Q000517:prevention & control*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome